THEORY OF MIND IN AUTISM:
DEVELOPMENT, IMPLICIATIONS & INTERVENTION
by Johanna Lantz, Graduate Assistant
Mind reading is often thought to be the activity
of psychics, but in a sense most of us are mind readers, or at least
we have a theory of mind. The concept of theory of mind can be difficult
to grasp, as is typical with any exploration into the mental world
of humans. This construct does not represent a single cognition,
behavior, or emotion. The mind is comprised of beliefs, desires,
emotions, perceptions, and intentions. Theory of mind is the ability
to attribute these mental states to self and others in order to
understand and predict behavior. It involves making the distinction
between the real world and mental representations of the world.
Individuals with Autism Spectrum Disorder tend to be less proficient
“mind readers” compared to people who are typical. Theory of mind
deficits can be used to explain the social and communication impairments
that define Autism Spectrum Disorder. This article will compare
the typical development of theory of mind with the development of
mental state understanding in individuals with Autism Spectrum Disorder.
Implications of theory of mind challenges will be discussed and
intervention approaches will be suggested.
Typical and Atypical Theory of Mind Development
Theory of mind development begins early in life,
as does the shift from the typical course of development that is
seen in children across the autism spectrum. Antecedents to theory
of mind development are evident in infancy. At 5 months of age,
typical children can recognize different facial expressions, but
understanding the meaning occurs a few months later. Once young
children are able to reliably interpret the facial expressions of
others, they begin to use this nonverbal information to guide their
behavior. For example, a toddler may look at his mother’s face for
cues about whether it is safe to approach an unfamiliar person.
Dawson and Osterling (1994) studied videotapes of first birthday
parties of typical children and children who later received a diagnosis
of Autistic Disorder and found that the best predictor of future
diagnosis was lack of attention to the face of others. Considering
this evidence, it is not surprising that young children with Autism Spectrum Disorder usually do not se the gaze of another to guide
Intention, or acting in a particular way either
consciously or unconsciously to bring about a desired outcome, is
also an early marker of theory of mind development. Within the first
year of life infants come to understand that the behavior of others
is goal-directed. Children with autism spectrum tend to use people
as objects. For example, they may grab an adult’s hand and use it
to reach a desired item. Intentional communication begins in infancy
in the form of gestures and moves to simple language. Joint attention
is a form of intentional communication and refers to behaviors such
as pointing to or bringing an object of interest to another person
to share enjoyment, or changing eye gaze to share attention with
another. Children with autism are less likely to use joint attention,
but may point to request an object. In addition, the use of gestures
to communicate is often strikingly absent in people with Autism Spectrum Disorders across ages. To summarize, children with Autism Spectrum Disorders often fail to develop the prerequisites of theory
Typically developing two year olds engage in pretend
play and demonstrate some understanding of pretense. Two year olds
with autism usually do not engage in pretend or imaginative play;
rather, their play tends to be limited to the exploration of the
physical aspects of toys. Children with autism rarely imagine an
object to be something that it is not (e.g., pretending a block
is a car). At approximately two years of age, typical children can
predict the desires of others. In other words, they can understand
what other people may want, and that this may be different from
their own desires. Children with autism have less difficulty understanding
simple desires compared to other mental states such as beliefs,
but they still lag behind their typical peers in this area of development
Most investigation of theory of mind development
has focused on 3 to 4 year old children. It is evident that between
the ages of 3 to 4 there is rapid development in this area. Three
year olds typically fail to recognize their own and other’s false-beliefs
(holding beliefs that conflict with reality). Wimmer and Perner
(1983) developed a means of measuring false-belief understanding,
and although many subsequent studies have modified the task, the
classic false belief task is as follows:
A character named Maxi places a chocolate candy
in a kitchen cabinet and leaves the room to play. While he is playing,
his mother enters the room and moves his candy into a drawer, without
Maxi witnessing this switch. Then, Maxi returns and the child participant
is asked where Maxi will search for his candy, in the cabinet or
the drawer. Often the child is asked where they believe the candy
is located as well.
Correct responses to false-belief tasks increase
with age: children at 30 months answer false-belief questions correctly
only about 20% of the time, children at 44 months are correct about
50% of the time, and at 4 years of age children perform better than
chance, answering most correctly (Wellman et al., 2001). Various
studies have shown that the majority (around 80%) of children with
autism, even those with average intelligence, fail measures of false-belief
(Baron-Cohen, 1993). In other words, children with autism across
the age span will often answer that Maxi will immediately search
for the candy in the drawer. As typical children mature, they increasingly
would understand Maxi’s perspective and would suggest that Maxi
would search for candy in the cabinet.
Typical 3 year old children understand the simple
emotions of others, but have difficulty understanding feelings such
as surprise that are the result of mistaken beliefs. By the age
of 5, children can recognize feelings that are the result of an
unexpected outcome (Hadwin & Perner, 1991). For example, a 5
year old understands that Maxi is surprised because he thought the
chocolate was in the cabinet, but it was not there when he looked.
For individuals with autism, difficulties with emotional understanding
persist throughout life.
Research on theory of mind has traditionally focused
on preschool children because this is when there is an apparent
rapid development of mental state understanding. Less is known about
theory of mind in older children, although there is acknowledgement
that further development occurs in this area as children mature.
During the school years, children learn to understand that people’s
actions do not always reflect their true inner feelings, and that
people can have a variety of feelings at one time, some of which
conflict. School-aged children understand irony, sarcasm, ”white
lies”, the distinction between literal and non-literal speech, and
metaphors indicating more advanced ability to understand the beliefs
of others. Individuals with Autism Spectrum Disorders often struggle
with these aspects of communication, even when they have almost
typical language. This is a particularly salient feature of Asperger’s
Implications of Theory of Mind Difficulties
Theory of mind difficulties can provide a possible
explanation for the communication and social challenges that define
Autism Spectrum Disorders. Howlin, Baron-Cohen, and Hadwin (1999)
further identified deception, empathy, self-consciousness, and the
use of persuasion as being dependent on theory of mind understanding.
Imagine trying to understand and interact with other people without
knowing their thoughts, feelings, or beliefs. Consider the following
A woman is presenting the status of a project
she has been working on at the end of a long staff meeting. Toward
the middle of her presentation she notices a colleague looks at
her watch and sighs. A man at the meeting starts to nod off while
others become fidgety. Her boss asks her to “wrap it up” and even
though she is not finished, she decides to end her presentation.
As people begin to exit the room, her colleague who was on the verge
of falling asleep while she was talking tells her that her project
sounds very interesting.
Typical people often take for granted how much
we use our understanding of other people’s thoughts and feelings
to guide our social interactions. In the example above, the speaker
was able to read the nonverbal cues of others indicating that they
were bored and tired; consequently, she decided to end her presentation.
The presenter did not take the phrase “wrap it up” literally, and
she knew that the boss intended “it” to mean the presentation, even
though this had to be implied from the context. Finally, the speaker
probably realized that her sleepy colleague’s comment about her
project is probably a “white lie”, and that his comment did not
match his belief or behavior, but instead reflected his desire to
please her. Now imagine being a person with an Autism Spectrum Disorder
faced with a situation similar to the scenario presented above.
An individual within the autism spectrum most likely would have
behaved differently as a result of not being privy to the mental
states of others.
In individuals with Autism Spectrum Disorders,
theory of mind difficulties have a definite impact on their ability
to interact in the social world. People with autism may not understand
the many unwritten social rules that exist in the “neurotypical”
culture, and that these rules often change with the context. For
example, a man with an Autism Spectrum Disorder may be told that
it is okay to ask close friends or children how old they are, but
it is considered impolite to ask strangers or older people their
age. Now imagine he accepted a job at a license branch and is told
to verify the age of the customer. He would likely become upset
because in his mind this is breaking the rules. Another implication
of the inability to “mind-read” is that people with Autism Spectrum Disorder may talk endlessly about a topic and may not be able to
detect the listener’s nonverbal signals that they are not interested.
Individuals across the spectrum may be brutally honest and in return,
take all words as truth. This also leads to problems understanding
deceit, which can put their safety at-risk. People with autism may
not understand that an event they experienced was not experienced
by all, so they may not be able to provide the background necessary
to be understood by others. For example, a man with an Autism Spectrum Disorder gets on the wrong bus and is consequently late for work.
He might not understand that he needs to explain
to his employer why he is late, because he assumes his boss knows
the reason. From these few examples, it becomes easy to see how
confusing life can be when you have trouble understanding the thoughts
and feelings of others.
Developing “Mind-Reading” Skills
To address the theory of mind challenges faced
by individuals across the autism spectrum, Howlin, Baron-Cohen and
Hadwin (1999) developed an intervention guide entitled, Teaching
Children with Autism to Mind-Read: A Practical Guide. The Guide
provides information on how to teach theory of mind skills to individuals
across the autism spectrum while taking into consideration the developmental
stages of theory of mind acquisition. The program was developed
for children ages 4-13 whose language ability is at about the 5
year old level, but the authors encourage teachers to make adaptations
to suit individuals of any age or ability level. The Guide is divided
into three instructional areas as follows:
Activities designed to help children understand
the emotions of others include instruction in recognizing facial
expressions from photos and schematic drawings, and identifying
situation-, desire-, and belief-based emotions.
The second part of the Guide offers instruction
in simple and complex visual perspective taking; understanding that
“seeing leads to knowing”; predicting actions on the basis of a
person’s knowledge; and understanding false-beliefs.
The last section of the Guide suggests activities
to promote the development of play skills from the child’s current
level of functioning (e.g., sensorimotor play) to pretend play.
The Guide includes information on how to assess
and establish a baseline of the child’s current level of functioning
and provides record forms to track progress after each session.
Teaching procedures and suggested materials are also identified.
The authors encourage the use of reinforcement of correct responses
and “error-free” teaching, where the child is prompted to make correct
responses. In addition, they suggest always starting a session with
mastered skills before proceeding to more difficult tasks. The Guide
provides a practical approach to instruction in theory of mind that
can be used in both clinical and educational settings.
Carol Gray’s book, Comic Strip Conversations,
is another resource available to help individuals with Autism Spectrum Disorders develop theory of mind understanding. This activity involves
using simple drawings to illustrate conversations between people.
With the help of a parent or professional, participants
use drawings to comprehend problem situations and to communicate
ideas in conversational form. They are asked to identify what people
do, say, and most importantly, think in social situations. Color
is added to the comic strips to represent emotion.
This activity is versatile, is easy to implement
in any setting, and capitalizes on the visual processing strengths
of individuals with Autism Spectrum Disorders. Catherine Faherty
developed a workbook for children or adolescents with Autism Spectrum Disorders entitled, What Does It Mean To Me?. The purpose of this
workbook is to help children with autism learn about autism and
to develop self-awareness. There are two parts of each chapter.
The first section contains worksheets for the child and parent or
professional to complete together. The second section provides additional
suggestions for the home and school environment. Although the entire
workbook is not specifically designed to increase theory of mind
understanding, several worksheets within the text are appropriate
for this purpose.
An additional resource that contains suggestions
and activities that target theory of mind challenges is Jeanette
McAfee’s book entitled, Navigating the Social World. McAfee’s text
is designed for use by parents, professionals, and paraprofessionals
who live or work with individuals with Asperger’s Syndrome or high-functioning
autism. The book contains programs meant to help individuals
gain social and emotional skills, including activities that target
theory of mind understanding. Tasks are designed to complement the
learning style of people with Autism Spectrum Disorder. For example,
activities are broken down into steps and are repeated until mastered.
The use of reinforcement is encouraged to maintain motivation. McAfee’s
book offers numerous strategies that are practical and easy to implement.
Theory of mind, the ability to attribute mental
states to self and others in order to understand and predict behavior,
is an area of weakness for individuals across the autism spectrum.
The development of theory of mind begins in infancy, as does the
shift from the typical course that is seen in children with Autism Spectrum Disorders. While the peak in theory of mind development
occurs in typical children from the age of 3 to 4, mental state
understanding in individuals within the spectrum often continues
to be conspicuously absent throughout the lifespan and leads to
significant social and communicative challenges. Many practical
resources are available to help parents, teachers, professionals,
and paraprofessionals teach and support people with Autism Spectrum Disorder become better “mind-readers.”
Baron-Cohen, S. (1993). From attention-goal psychology to belief-desire
psychology: the development of a theory of mind, and its dysfunction.
In S. Baron-Cohen, H. Tager-Flusberg, and D.J.Cohen (Eds.), Understanding
Other Minds: Perspectives from Autism (pp.59-82). New York: Oxford
Dawson & Osterling (1994). Early recognition of children with
autism: A study of first birthday home videotapes. Journal of Autism
and Developmental Disorders, 24, 247-257.
Faherty, C. (2000). What does it mean to me? A workbook for explaining
self-awareness and life lessons to the child or youth with high-functioning
autism or Aspergers. Arlington, TX: Future Horizons.
Gray, C. (1994). Comic strip conversations: Colorful illustrated
interactions with students with autism and related disorders. Jenison,
MI: Jenison Public Schools.
Hadwin, J., & Perner, J. (1991). Pleased and surprised: Children’s
cognitive theory of emotion. In G.E. Butterworth, P.L. Harris, A.M.
Leslie, & H.M. Wellman (Eds.), Perspectives on the child’s theory
of mind (pp.215-235). New York: Oxford University Press.
Howlin, P., Baron-Cohen, S., & Hadwin, J. (1999). Teaching children
with autism to mind-read: A practical guide. New York, NY: John
Wiley & Sons.
McAfee, J. (2001). Navigating the social world: A curriculum for
educating individuals with Asperger’s Syndrome and high-functioning
autism. Arlington, TX: Future Horizons, Inc.
Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation
and constraining function of wrong beliefs in young children’s understanding
of perception. Cognition, 13, 103-128.
Wellman, H.M., Cross, D., & Watson, J. (2001). Meta-analysis
of theory-of -mind development: The truth about false-belief. Child
Development, 72, 655-684
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