Theory of Mind in Autism Spectrum Disorder
By: Bipasha Sharma
Have You Ever Played Hide and Seek With a Little Child?
Whenever we play Hide and Seek with very little children, something very surprising happens- they don’t completely hide; they just close their eyes or hide their faces, not their bodies. It’s as if they assume that if they can’t see anything, you wouldn’t be able to see anything either.
In 1978, Premack and Woodruff raised a question, “Does the chimpanzee have a theory of mind?” from where enormous research on the concept of theory of mind started taking place. Researches started questioning whether even children had a Theory of Mind.
What is Theory of Mind?
Theory of Mind (ToM) is the inability to ascribe the states of mind to another person or to oneself. To explain this further, let’s get back to the example of Hide and Seek, here the children closing their eyes might be explained as their inability to understand that the other person also holds a set of thoughts, beliefs, values, etc. that are different from their own.
This ability is formalized into the term ‘Theory of Mind’. ToM is sometimes used interchangeably with the term ‘Mentalization’, and a deficit of which is also called ‘Mind-blindness’.
Test Your Theory of Mind
Imagine two boys, Tim and Jim playing with a toy. Tim decides to go out for a walk and puts the toy in the Green Box. While Tim is away, Jim plays with the toy and later puts the toy in the Black Box.
When Tim will return, where will he look for the toy?
An adult might say that Tim would first look in the Green Box, and when he doesn’t find it there; he might assume the toy had been moved, so he would then look for it in the Black Box. If you answered it this way, you have a Theory of Mind. You’ve understood that the other person might also have feelings, thoughts and beliefs that might not match your own.
If children were asked the same question, they might just simply say the ‘Black Box’, without being able to understand why Tim would go to the Green Box in the first place. This is because children cannot understand other’s mental states.
Normally, in the early childhood years, the ability of a child to ascribe the states of mind to another person or to oneself is not present; however, this ability intrinsically develops as the child grows older. Approximately by the age of four, the child develops a ToM.
Do People with Autism Spectrum Disorder Have a Theory of Mind?
Autism Spectrum Disorder (ASD) is a Neurobiological Disorder that significantly impairs children’s social interaction, verbal and nonverbal communication, and behaviours. Baron-Cohen (2000) mentioned that the core cognitive aspects of ASD are weakening of central coherence, executive dysfunction and the difficulty to reflect on the contents of the mind of oneself and other person (ToM).
The presence of ToM can be figured out by the use of False Belief Tasks which helps in examining an individual’s ability to infer the other person’s level of knowledge that might or might not be true. Children with ASD commonly fail False Belief Tasks. Even at an older Chronological and Mental Age, people with ASD persist to have difficulties with ToM.
As of now, Theory of Mind doesn’t have specific neuropsychological cause. The deficit isn’t attributed to one single area of the Brain, however neural bases might be widely spread. Some studies also show that they might be a cause of Brain Damage in Frontal Cortex or in the Temporo-parietal region.
How Is the Development of ToM Different in ASD From Normal Development?
Preschoolers with ASD might develop ToM slower than children with normal development. However, preschoolers with High Functioning Autism Spectrum Disorder (HF-ASD) might develop ToM comparatively faster than Low Functioning ASD. It is mostly during the Elementary School, approximately at the age of nine, when children with ASD pass the False Belief Tasks. It is an approximate five year delay. By adolescence, they might be able to successfully pass the tests. Researchers also hypothesize that individuals with HF-ASD might pass False Belief Tasks by the help of their intellectual capacity.
Passing the test doesn’t predict smooth social functioning. They might still have to put effort into understanding implicit meaning of sentences, for example, difficulty understanding sarcasm. For tasks like these, they would require effortful calculation.
How Does Theory of Mind Affect Individuals with ASD?
People with ASD often are unable to understand that other people might not have similar things in their mind as theirs. For example, they might assume you like Rock music just because they do, or they might abruptly talk about something new assuming that you would already know about it as they do not realize that you have a different mental state.
ToM is linked to abilities of language, executive functioning and central coherence. The better the language or comprehension abilities of the child with ASD, the better chances of the child to pass False Belief Tasks. But predicting False Belief Tasks in children with ASD is especially difficult because of the problems in executive function and cognitive shifting.
In an experiment, a child with ASD was shown a candle that looked like an apple. The child couldn’t understand the dual-identity of the candle. Some said it’s a only a candle and the others said it’s just an apple. This tested their ability of the child to distinguish between the appearance and reality of an object, whose deficit is associated with ToM.
Communication and Social Interaction: People with ASD often develop their language skills late in life, which contributes to the slow development of ToM, and consequently their social skills. ToM deficit is often seen as the root cause of poor social skills in ASD. As a consequence, they might not be able to make friends, develop empathy towards others, problems in understanding facial expressions, body language, etc.
A core aspect in the recognition of a deficit in ToM is the inability to manipulate the behaviour of others. In the game of Hide and Seek for example, where the main goal of the hider is to deceive, people with a deficit in ToM might blurt out where they are hiding.
Academics: In terms of their academic ability, individuals with ASD/HF-ASD often have a hard time with reading comprehensions and narratives. They might find it difficult to relate to the characters or understanding their intentions. Hence, they might make errors in interpreting such texts that are not consisting of facts.
Can Theory of Mind Be Taught?
A licensed Psychologist uses several techniques can help in developing ToM in children, adolescents and adults. The intervention developed for ToM is different from the typical treatment designed for ASD. Many ASD intervention models focus on the behavioural and personal aspect of the individual by the use of structured timetables and conditioning. Whereas ToM model of ASD focuses more on the False Belief Tasks and social and communication difficulties. Majority of the treatments are geared to improve ToM by teaching individuals to recognize the internal, subjective mental representations of their own selves and others around them.
For example, cartoon thought-bubbles might be used as an instrument for depicting mental states to children. Interventions in a group-setting might involve teaching the skill of listening, basic socializing, perceiving and imitating, differentiating fantasy from reality and recognizing other’s mental states. First order mental state reasoning might also be taught on areas like deceit and deception, imagination and understanding of humour. Some might even integrate technology and use video modeling and role playing to create social scenarios to help adolescents and adults with ASD solve real life problems.
What Can the Parents and Teachers Do?
It is important to know that there are certain limitations of ToM interventions along with the benefits, and to bridge this gap, parents and teachers play an important role.
Even if the learning does takes place in the clinical environment, the probability of the behaviour being generalized to real day-to-day life is very low. There is greater generalization when teachers/educators/parents are psychoeducated about the training.
They play a vital role in encouraging outings and helping individuals with ASD replicate the learning to different social settings, eg. Practicing at home or school.
The parents need to attend feedback meetings with the professional working with the child to help not only inculcate new techniques to effectively deal with the child, but also bring changes on a personal level to be able to correctly reinforce the behaviour of the individuals with ASD.
The self-esteem and quality of life of children with autism is often neglected. Due to consistent social rejection and other difficulties in day-to-day functioning, individuals with ASD face many more setbacks than an average human being. Parents and teachers should give frequent positive reinforcements to help the child develop healthily and build confidence in their abilities. This aspect also plays an important role in the efficacy of the treatment.
