Unlocking the Mystery of Social Deficits in Autism: Theory of Mind as Key
Blacher, Jan, Howell, Erica, The Exceptional Parent
What is Theory of Mind and Why Should You Care?
Simply put, theory of mind, or ToM, is key to the development of one's social skills. Without ToM, children (or adults) cannot understand or infer the thoughts, feelings, or intentions of others. A lack of ToM skills is considered by some to be a core deficit in autism. Interest in this concept has been popularized by Simon Baron-Cohen, a researcher at the University of Cambridge, U.K., and Helen Tager-Flusberg, a researcher at Boston University. This type of disability, or of deficit, may go a long way to explain some of the difficulties that children with autism have in play, social communication, and other forms of perspective-taking.
Many parents of individuals with autism can recount humorous, and sometimes embarrassing, stories that revolved around their son's or daughter's lack of social skills. One mother recalled when her 12-year-old son asked an overweight neighbor when her baby was due. He didn't recognize the neighbor's mortification at the question nor did he consider how hurtful his words were. Another described how she "tenses up" when her son spots a passer-by wearing a large watch. He would typically charge ahead, grab the person's wrist, and adeptly recite the time. He didn't realize how uncomfortable this made the stranger feel. Often, children lacking ToM skills don't understand when something is humorous or when they are being teased.
How does Theory of Mind impact individuals with autism?
ToM affects all interpersonal interactions as well as academics, daily living, following directions, and understanding socially-based information. For children with autism spectrum disorder (ASD), problems such as emotion recognition and sharing, understanding knowledge, deception, humor, teasing, and describing one's mental state or feelings are related to ToM impairment. Oftentimes, individuals with ToM deficits are unable to form successful relationships with others, with resulting loneliness or, worse yet, symptoms of depression. This is more common in children and adolescents with high functioning autism or Asperger syndrome.
ToM skills are continually required throughout the day to help navigate the social world. Kids who are not socially aware of group dynamics among peers (this is called "social referencing") may walk through the middle of a basketball game at recess or interrupt an ongoing conversation among friends. A student who has difficulty inferring the intentions of others may wrongly accuse classmates of bumping into him on purpose, instead of recognizing that the hallway at school is particularly crowded. Without skills in understanding non-verbal behavior and perspective-taking, a student with autism might talk continuously about trains to his peers, ignoring their bored stares. Parents of children with ASD can readily provide other examples of social problems that occur because of their child's lack of social perspective-taking.
Can Theory of Mind be taught?
Although there are few interventions targeting ToM skills, there is some research evidence that these skills can be taught, at least to a limited extent. Hadwin, Baron-Cohen, Howlin, and Hill taught nine-year-old students with autism how to identify and understand emotions, perspective-taking activities, and pretend play skills. At the end of this short, eight-day study, the children had improved their ability to pass emotion and perspective taking tasks, although their social communication skills in a naturalistic setting remained unchanged. This may indicate that while the children were better at completing the tasks, the short intervention was not sufficient to improve their ToM skills so that there was an observable social impact.
Ozonoff and Miller implemented a longer intervention on ToM skills for adolescent boys with autism. The children met one time a week for four and a half months to receive conversational skills training (i. …