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Does the autistic child have a “theory of mind”?

Does the autistic child have a “theory of mind”?


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Theory of Mind involves understanding another person's knowledge, beliefs, emotions, and intentions and applying that knowledge to navigate the social world.


Theory of mind refers to an ability to recognize that others have a mind, and that others may have knowledge/beliefs/motivations that are different from their own.

Children (and adults) with autism as a group have deficits in tests meant to assay theory of mind, though of course the degree of impairment depends on the individual and different tests may give different results.

Tests that assay theory of mind are often dependent on other skills, however, including language and visual social skills (such as eye contact) that are also often impaired with autism, making it more difficult to separate out those related skills from theory of mind itself. However, even after controlling for language skills, people with autism still have deficits in theory of mind.

I don't think it is correct to think of theory of mind as a binary yes/no, although some approaches to the concept do treat it as such. Neurotypically developing children show different elements of the theory of mind at different stages of development. Sometimes theory of mind is separated into "orders", where higher functioning people with autism tend to have more issues with second-order theory of mind, where one recognizes not only that someone else has a mind of their own but also that a third person is able to think about that person's thoughts.

Some individuals with autism who have theory of mind deficits are still able to develop skills to cope and can understand cognitively that others have minds different from their own. Importantly, however, "theory of mind" itself refers to an innate cognitive ability, sort of a natural or automatic accounting for the thoughts of others.


Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”?. Cognition, 21(1), 37-46.

Baron‐Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child psychology and Psychiatry, 38(7), 813-822.

Baron-Cohen, S. (2000). Theory of mind and autism: A fifteen year review. Understanding other minds: Perspectives from developmental cognitive neuroscience, 2, 3-20.

Frith, U., & Happé, F. (1994). Autism: Beyond “theory of mind”. Cognition, 50(1-3), 115-132.

Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Executive function deficits in high‐functioning autistic individuals: relationship to theory of mind. Journal of child Psychology and Psychiatry, 32(7), 1081-1105.


Absence of spontaneous false belief attribution in individuals with ASD

Spontaneous theory of mind is critical not only for infants, but also for adults. Unlike experiments, the real social world is fluid and rapidly changing. We have to process socially relevant information rapidly, spontaneously and on-line, in order to achieve day-to-day social interaction. Let’s return to the hypothetical social situation described at the beginning of this article. To achieve good social interaction with your partner, you have to detect all the relevant information (e.g. her facial expression, gaze and utterances), predict her behaviour (e.g. looking for the chocolate in the cupboard), and act quickly. All these cognitive operations need to be conducted spontaneously, as in daily social interaction it is highly unlikely that you will be offered explicit information about another person’s mental state. For example, you wouldn’t expect your partner to ask “Where do you think I will look for the chocolate?”. Thus the absence of spontaneous theory of mind would cause difficulty in social interaction and communication, even in adults with high verbal and cognitive skills.

We hypothesized that individuals with high-functioning autism spectrum disorder, even though they can easily pass standard false belief tests ( Figure 1 ), do not pass the spontaneous false belief test. To test this hypothesis, we used the same experiment as with 2-year-old infants on adults with Asperger Syndrome. Asperger Syndrome is a sub-category of ASD, with similar symptoms but no developmental delay in verbal skills (American Psychiatric Association, 2000). In our experiment (Senju, Southgate, White, and Frith, 2009), 19 adults with Asperger Syndrome watched the video stimuli we used in Southgate and others (2007), and their eye movements were recorded with an eye-tracker. No instruction was given to the participants. For comparison with typical development, we also recruited 17 neurotypical adults with similar age, gender ratio and general cognitive skills. All participants in both groups passed standard false belief tests. All participants also showed anticipatory looking by the end of familiarization trials, suggesting that adults with Asperger Syndrome, as well as neurotypical adults, spontaneously anticipate another person’s action based on her goal.

However, the test trials showed a very different picture. The Asperger group showed significantly less anticipatory looking toward the correct side than the neurotypical controls did. A follow-up analysis revealed that the anticipatory looking of neurotypical controls were significantly biased to the correct location. This is not the case for Asperger group, whose anticipatory looking behaviour was not biased to either side ( Figure 3 ).

(A) Mean (± SEM) difference looking scores (DLS) and (B) the ratio of the number of participants who made correct first saccades in each group. DLS is calculated by subtracting the looking time for the incorrect window from correct window, and then dividing the difference by the total of the looking times in both correct and incorrect windows. AS: participants with Asperger Syndrome (N = 19), NT: neurotypical participants (N = 17), *: p < .05, **: p < .01, dotted lines: chance level, statistical test used: (A) t-test and (B) binominal test. Reproduced, with permission, from (Senju and others, 2009).

Our study demonstrates that adults with Asperger syndrome do not spontaneously anticipate others’ actions in a nonverbal task, closely modelled on the standard false belief test which they pass with ease. In particular, the contrast with neurotypical 2-year-olds who showed spontaneous looking to the correct location on the same task (Southgate and others, 2007) is quite notable. It is unlikely that the general lack of motivation is to blame, as all the participants in the Asperger group showed correct anticipatory looking in the familiarization trials, in which false belief attribution is not necessary.

The results of this study are consistent with the clinical profile of high-functioning individuals with ASD, who show difficulties in social communication in real life despite performing fairly well in a well-controlled experimental or training context. It is also consistent with the findings that training on false belief tests does not necessarily improve social adaptation in ASD (Ozonoff and Miller, 1995): the capacity for false belief attribution may not be sufficient to deal with its spontaneous use in a fluid and rapidly changing “real” social world.

Why do individuals with ASD fail to develop spontaneous theory of mind? There are at least two possibilities. Firstly, they may have a modular impairment in theory of mind (Leslie, Friedman, and German, 2004), and thus have to develop compensatory strategies to infer other people’s mental states. Such a compensatory strategy may not be efficient enough to infer mental states spontaneously and effortlessly in the fluid and rapidly-changing social environment. Secondly, it is possible that socially relevant cues, such another person’s gaze direction or emotional expression, do not spontaneously recruit social cognition in ASD. For example, a recent study demonstrated that infants at high risk to develop ASD showed a slower and less organized cortical response to others’ gaze direction (Elsabbagh and others, 2009), even though they have no difficulty in spontaneously orienting to another person’s eyes (Chawarska and Shic, 2009). Note that these two possibilities are not mutually exclusive because an early impairment in processing socially relevant information may lead to an atypical development of theory of mind (Senju and Johnson, 2009). Further developmental studies will be necessary to understand the developmental trajectory of spontaneous and deliberate theory of mind, both in typically developing individuals as well as in individuals with ASD.


Do Children With Autism Understand What Others Think or Feel?

Nicholas R. Metrus, MD, is a board-certified neurologist and neuro-oncologist. He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey.

"Theory of mind" describes the human ability to understand that it is impossible for one person to know what is going on in another person's mind. "Theory of mind" sounds like a complex concept, but in fact, it's usually mastered by children before they're five years old.

A child who has mastered theory of mind understands that for example:

  • If they hide, other people don't know where they are.
  • If they think a thought or have an emotion, but don't express it, that thought or emotion is not communicated to others (and that others may not share all their thoughts).
  • Their likes and dislikes may or may not be shared by others and others may have completely different preferences and tastes.
  • They have information that someone else does not have, they must communicate that information or risk being misunderstood.
  • If they witness something that others don't witness, they know something that other people don't know.

For a number of years he was a Medical Research Council Senior Scientist at the University of London. He joined the faculty at Rutgers University in 1993. He has also worked as a visiting professor at the Universidad Autonoma in Madrid, Spain, the University of Chicago, and the University of California, Los Angeles. In 2005 he gave the XIII Kanizsa Memorial Lecture at the University of Trieste and in 2006 he was the inaugural recipient of the Ann L. Brown Award for Excellence in Developmental Research. In 2008 Dr. Leslie was designated a Fellow of the Association for Psychological Science [1] and he was also elected to the American Academy of Arts and Sciences [2].

Leslie was a member of the team in London who, in 1985, discovered the theory of mind impairment in autism. Autism manifests as the inability to communicate with others, and an obsession with a restricted repertoire of activities. In 1985 Alan Leslie, along with Simon Baron-Cohen and Uta Frith, published the famous article Does the autistic child have a 'theory of mind'? in which it was suggested that children with autism have particular difficulties with tasks requiring the child to understand another person's beliefs.

He is interested in the design of the cognitive system early in development. He has contributed a number of influential experimental studies and theoretical ideas on the perception of cause and effect, object tracking, and agent detection in infancy, the developmental role of modularity of mind, and the Theory of Mind Mechanism (ToMM) in the development of social cognition and its impairment in autism.


It’s Harder For Me To Remember Sequences

Have you noticed that sometimes I start something you told me to do and get stuck halfway through the task?

Maybe you asked me to do the laundry, and explained in detail what I should do.

So I collected the clothes from each bedroom.

I brought them to the basement.

I opened the washer and put the clothes in.

But I can’t remember what my next step is.

Whether it’s giving directions to get from my house to school or a list of chores that need to be done today, I will be more successful if you write out the steps.

Picture charts can be helpful to keep me on track with getting up or going to bed routines. Color-coding where things belong in the kitchen or my bedroom also helps.


Theory of mind and autism spectrum disorder

Theory of mind (Premack & Woodruff, 1978) is the ability to understand the contents of another person’s mind, including their knowledge, emotions, beliefs, and intentions (Kloo et al, 2010). It is essential for social cognition (Astington & Edward, 2010), referential communication (Sidera et al, 2018), and better theory of mind is associated with better social interaction skills (Bosacki and Astington, 2001).

While the classical theory of children cognitive development states that most children possess a developed theory of mind at around age nine (Piaget & Cook, 1952), recent research suggests that theory of mind continues to develop during teenagehood and adulthood (Dumontheil et al, 2010 Henry et al, 2013 Valle et al, 2015).

Theory of mind is often measured using the false-belief test, which evaluates people’s representation of a protagonist’s beliefs and intentions (Wimmer & Perner, 1983). Using a version called the Sally-Anne test, where children are asked to guess where “Sally” will look for an object after “Anne” moved it while she was away—thus needing to take Sally’s perspective—researchers found that children with autism spectrum disorder (ASD) consistently fail the false-belief test, and concluded that theory of mind may take longer to develop in individuals with ASD (Baron-Cohen et. al, 1985).

Individuals with ASD typically suffer from rigid and repetitive speech (Van Santen et al, 2013), uneven language development (Boucher, 2012), and other forms of social and communication deficits (Kanner, 1943 Lord et al, 2000). These social and communication problems may be explained by the delay in the development of theory of mind observed with individuals with ASD, also called mind blindness, and consisting in an impairment of the neurocognitive mechanism allowing them to mentalise (Frith, 2001).

Research supporting this link between mind blindness and the limited social and communication abilities of individuals with ASD show evidence that theory of mind is an accurate predictor of severity in the diagnosis of ASD: lowest levels of theory of mind skills are correlated with more severe diagnoses (Hoogenhout & Malcolm-Smith, 2016).

On the other hand, while their success at the test is not predictive of competent social and conversational interaction, children with ASD passing the false-belief test tend to exhibit fewer everyday social and conversational difficulties than those who fail (Peterson et al, 2009). This impact on social and communication ability seems to stem specifically from the development of theory of mind: social cognitive skills which do not involve mental state attribution, such as visual self-recognition, do not seem to be impaired in individuals with ASD (Dawson, 1984).

However, while a plausible explanation, researchers have expressed doubts as to what extent theory of mind can account for the social and communication problems within the ASD, arguing that ASD is a complex disorder in which no single cognitive mechanism can explain all the range of symptoms, including the social and communication problems (Tager-Flusberg, 2007).

One criticism is the lack of universality of theory of mind tests: some individuals with ASD pass false-belief tests, but still struggle to communicate in social situations. An experiment saw 24 adults with ASD pass a simple false-belief test, with no difference in latency or accuracy compared to the control group (Moran et al, 2011).

However, participants failed at the second part of the test, which was modelled after more realistic social situations and involved making moral judgements. An hypothesis is that individuals with ASD develop mechanisms to compensate for their lack of theory of mind, allowing them to use logic solve simple false belief tasks, but not addressing the more subtle aspects of moral judgment. This could be addressed with new theory of mind tests that prevent the use of these compensatory mechanisms (Brewer et al, 2017).

Another is that theory of mind tests may lack specificity: clinical groups with other disabilities but not ASD such as deaf children tend to fail more often the traditional false-belief tests (Peterson Siegal, 1995). However, failing a false-belief test may reflect language difficulties rather than theory of mind difficulties, as discussed in research with children and adolescents with intellectual disability but not ASD (Abbeduto et al, 2004).

Finally, some researchers argue that theory of mind is not the core source of social and communication problems in individuals with ASD. Alternative or complementary explanations that are supported by some evidence include a lack of social motivation, which suggests that children with autism do not find social stimuli intrinsically rewarding, resulting in a lack of social interest (Dawson et al, 2004 Chevallier et al, 2012). Further research is needed to assess these theories as potential alternatives or additions to the theory of mind explanation.

Abbeduto, L., Short‐Meyerson, K., Benson, G., & Dolish, J. (2004). Relationship between theory of mind and language ability in children and adolescents with intellectual disability. Journal of Intellectual Disability Research, 48(2), 150-159.

Astington, J. W., & Edward, M. J. (2010). The development of theory of mind in early childhood. Social Cognition in Infancy, 5, 16.

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”?. Cognition, 21(1), 37-46.

Brewer, N., Young, R. L., & Barnett, E. (2017). Measuring theory of mind in adults with autism spectrum disorder. Journal of autism and developmental disorders, 47(7), 1927-1941.

Bosacki, S., & Wilde Astington, J. (1999). Theory of mind in preadolescence: Relations between social understanding and social competence. Social Development, 8(2), 237-255.

Boucher, J. (2012). Research review: structural language in autistic spectrum disorder–characteristics and causes. Journal of Child Psychology and Psychiatry, 53(3), 219-233.

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in cognitive sciences, 16(4), 231-239.

Dawson, G., & McKissick, F. C. (1984). Self-recognition in autistic children. Journal of Autism and Developmental Disorders, 14(4), 383-394.

Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Developmental psychology, 40(2), 271.

Dumontheil, I., Apperly, I. A., & Blakemore, S. J. (2010). Online usage of theory of mind continues to develop in late adolescence. Developmental science, 13(2), 331-338.

Frith, U. (2001). Mind blindness and the brain in autism. Neuron, 32(6), 969-979.

Frith, U. (2004). Emanuel Miller lecture: Confusions and controversies about Asperger syndrome. Journal of child psychology and psychiatry, 45(4), 672-686.

Henry, J. D., Phillips, L. H., Ruffman, T., & Bailey, P. E. (2013). A meta-analytic review of age differences in theory of mind. Psychology and Aging, 28(3), 826.

Hoogenhout, M., & Malcolm-Smith, S. (2017). Theory of mind predicts severity level in autism. Autism, 21(2), 242-252.

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous child, 2(3), 217-250.

Kloo, D., Perner, J., & Giritzer, T. (2010). Object-based set-shifting in preschoolers: Relations to theory of mind. Self-and social-regulation: Exploring the relations between social interaction, social cognition, and the development of executive functions, 193-218.

Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., … & Rutter, M. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of autism and developmental disorders, 30(3), 205-223.

Moran, J. M., Young, L. L., Saxe, R., Lee, S. M., O’Young, D., Mavros, P. L., & Gabrieli, J. D. (2011). Impaired theory of mind for moral judgment in high-functioning autism. Proceedings of the National Academy of Sciences, 108(7), 2688-2692.

Peterson, C. C., & Siegal, M. (1995). Deafness, conversation and theory of mind. Journal of child Psychology and Psychiatry, 36(3), 459-474.

Peterson, C. C., Garnett, M., Kelly, A., & Attwood, T. (2009). Everyday social and conversation applications of theory-of-mind understanding by children with autism-spectrum disorders or typical development. European Child & Adolescent Psychiatry, 18(2), 105-115.

Piaget, J., & Cook, M. T. (1952). The origins of intelligence in children.

Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind?. Behavioral and brain sciences, 1(4), 515-526.

Sidera, F., Perpiñà, G., Serrano, J., & Rostan, C. (2018). Why Is Theory of Mind Important for Referential Communication?. Current Psychology, 37(1), 82-97.

Tager-Flusberg, H. (2007). Evaluating the theory-of-mind hypothesis of autism. Current directions in psychological science, 16(6), 311-315.

Valle, A., Massaro, D., Castelli, I., & Marchetti, A. (2015). Theory of mind development in adolescence and early adulthood: the growing complexity of recursive thinking ability. Europe’s journal of psychology, 11(1), 112.

Van Santen, J. P., Sproat, R. W., & Hill, A. P. (2013). Quantifying repetitive speech in autism spectrum disorders and language impairment. Autism Research, 6(5), 372-383.

Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition, 13(1), 103-128.


Cognitive skills in children with autism vary and improve, study finds

People with autism spectrum disorders (ASD) are thought to have a specific profile of cognitive strengths and weaknesses -- difficulties appreciating others' thoughts and feelings, problems regulating and controlling their behavior, and an enhanced ability to perceive details -- but few studies have tracked children's cognitive skills over time. Now new longitudinal research provides clues that can inform our understanding of ASD.

"Parents and clinicians already know that the behavioral signs of ASD wax and wane throughout development," notes Elizabeth Pellicano, senior lecturer of autism education at the Institute of Education in London, who carried out the study. "What we know a lot less about is how the cognitive skills of children with ASD change over time. In this study, we found that these skills vary from child to child, and also that some of them can improve over time."

The research, which was conducted in Western Australia, appears in the September/October 2010 issue of the journal Child Development.

The cognitive strengths and weaknesses typically exhibited by people with ASD include difficulties predicting others' behavior based on their thoughts and feelings (so-called theory of mind) and problems regulating and controlling their behavior (termed executive function), combined with an aptitude for detecting parts of objects or small details (also called weak central coherence).

The study assessed 37 children with ASD and 31 typically developing children when they were 5 to 6 years old and again three years later. The researcher explored children's theory of mind by asking children to watch a series of social interactions on video and predict a character's behavior based on his or her mental state. She tested children's executive function by having them take part in problem-solving tasks that required them to plan ahead and show flexibility. And she assessed children's central coherence by asking them to construct patterns from wooden blocks and search for shapes hidden in pictures.

On the whole, Pellicano found, children with ASD exhibited the same profile that's typically associated with ASD, both at the start of the study and three years later. But a closer look at individual children's patterns of performance revealed that not all children with ASD displayed the same profile of cognitive strengths and weaknesses. Instead, the profiles of cognitive skills varied from one child to the next: For example, while one child with ASD showed difficulties in theory of mind alone, another child showed problems in theory of mind plus executive function.

Furthermore, although previous research has reported little change over time in theory of mind and executive function skills of children with ASD, this study found that most of the children's skills in these areas improved considerably over time: Most of the children had better appreciation of others' thoughts and feelings, and they were better able to plan, regulate, and control their thoughts and actions over the study's three years.

"These findings are encouraging," notes Pellicano. "They stress the importance of understanding the breadth of cognitive skills -- a set of weaknesses and strengths -- in children with ASD, and how these skills progress over time. A key question for the future is whether there are approaches that can facilitate progress in some of these areas."

Story Source:

Materials provided by Society for Research in Child Development. Note: Content may be edited for style and length.


What are your experiences?

I would love to hear from you!

Please comment below with any of your own experiences with children and the Theory of Mind. Did you perform the "False Belief Test"? And how did it go?

or any other thoughts or comments about the article would be kindly appreciated.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.


Implicit understanding:

Research suggests that many different aspects of language are important for developing theory of mind 2 . These include communication in social contexts, such as between mother and child or in peer interactions, knowledge of words and concepts referring to mental states, and complex grammar — especially sentence structures used to express mental states. Pyers and Senghas were not able to point to one particular aspect of language that makes the difference. It is interesting to note, however, that interacting with the younger, linguistically more sophisticated group was sufficient to enrich the vocabulary of the older cohort enough to allow them to talk about their own and other people’s thoughts and to pass false-belief tasks.

A key question remains: Before they had acquired the language of mental states, did the group of adults really fail to understand and interpret thoughts and beliefs in other people? To address this question, other kinds of studies that use implicit methods for testing false-belief understanding are needed.

One example of such a task uses eye tracking to see if children who do not pass classic false belief-tasks anticipate with their eyes where the person should look for the object. The first study to use this method found that toddlers look at the correct location while still failing to give the right verbal answer 3 . More recently, researchers have adapted these methods to probe implicit understanding of belief in even younger toddlers 4 .

One would expect that the deaf Nicaraguan adults are also able to demonstrate this level of implicit understanding, but no one has carried out this kind of study. Still, the study by Pyers and Senghas provides strong evidence that language is important for the emergence of a more explicit theory of mind, though it leaves quite open the mechanisms that drive these developmental changes at the linguistic, cognitive and neurobiological levels.


How Can We Use This Information?

As we continue to grow in our understanding of the mechanisms behind our own social behavior, there are some important takeaways from the research on the Theory of Mind and how it relates to the difficulties experienced by those with autism. First, it requires joint attention – the ability to follow another’s gaze and attend to the same stimuli. Second, it requires verbal communication to confirm and reinforce that the right stimuli is being attended to. Third, it requires a well-developed imitative repertoire. Lastly, it requires practice. Young children are constantly trained in perspective training when in the classroom, at the playground or even at home with their siblings. We ask, “How would you feel if someone grabbed your favorite toy from you?” And then we teach them how to attribute that same feeling to the offended party. Because children with autism do not engage in typical play, and thus do not often encounter these types of situations, they do not get a chance to practice these skills. However, we can create scenarios in which to practice perspective taking everyday. From talking about objects in the distance (joint attention) to labeling our own private events and modeling behaviors that alleviate them (I’m hungry so I’m going to get some food from the fridge), we can create experiences that can promote growth in this area and can ultimately lead to deeper connections with time and practice.

To learn more about the theory of mind autism connection or to learn about applied behavior analysis for children with autism spectrum disorder, contact Verbal Beginnings today at 855.866.9893.

By Francoise Nelson, M.S., RBT
Behavior Technician at Verbal Beginnings, LLC

References:
Baron-Cohen, S., Leslie, A., Frith, U. (1985). Does the Autistic Child Have A “Theory of Mind?” Cognition, 21 (1), 37 – 46.
Spradlin, J. and Brady, N (2008). A Behavior Analytic Interpretation of Theory of Mind. International Journal of Psychology and Psychological Therapy (Rev Int Psicol Ter Psicol), 8(3), 335-350.


Watch the video: Do People With Autism Lack Theory of Mind? (June 2022).


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