The development of a theory of mind in autism: deviance and delay?

Subjects with autism show severe impairments in the ability to attribute beliefs to themselves and others, i.e., in their "theory of mind." An experimental investigation of the relative comprehension difficulty posed in representing different mental states is reported in this chapter, revealing that certain mental states are easier to recall than others, for all subjects. For example, see and want are easier than believe. But whereas for normal children imagine and pretend are as easy as see and want, for people with autism they are significantly more difficult. Gopnik and Slaughter's three-stage model of normal development of a theory of mind is replicated in the present experiment and found to fit the pattern of results for people with mental handicap but not the data from autism. Instead, the data from autism seem to fit a hypothesis of both deviance and delay in the development of a theory of mind.     

Unauthorized minds: how "theory of mind" theory misrepresents autism

Recent representations of autism frequently include an assumption that autism is the result of a "theory of mind" deficit (i.e., an inability to understand others' mental states). This notion is examined using a social constructionist perspective. The belief that autism is a sort of "mind-blindness" has much in common with earlier representations of autism that depict it as a puzzle and, paradoxically, as a single entity defined by core characteristics. Theory of mind theorists also, like their predecessors, define autism as a form of insufficiency and as requiring fixing rather than accommodation. Alternative narratives about autistic minds that incorporate the perspectives of people labeled autistic are an important counterbalance to the limitations of such professional viewpoints.     

Reading the mind in the face and voice in parents of children with Autism Spectrum Disorders

One core feature of Autism Spectrum Disorders (ASD) is impairment in social functioning and inferring mental states and emotions referred to theory of mind (TOM). The “Broad Autism Phenotype” (BAP) proposes that defining features of autism express in milder form among first degree relatives of these patients. Theory of mind deficits has been examined using advanced TOM tasks such as “Reading the Mind in the Eyes”. This study has furthered previous findings using another test designed to tap higher TOM abilities named “Mind Reading in the Voice”. The objective of this study is to examine theory of mind abilities from two main communicative sources in parents of children with ASD in contrast to two groups, one clinical and one non-clinical. Forty-eight parents of individuals with autism, 31 parents of individuals with Down syndrome and 30 parents of typically developed children were administered two tests of mind-reading. Analysis revealed that although there is not a significant difference between three groups’ performance in “Mind Reading from Eyes”, parents of children with ASD have significantly lower performance in “Mind Reading from Voice”. It can be concluded that TOM deficits in parents of children with ASD are not restricted to inferring mental states form eyes and deficits in mind-reading from voice could also be a part of BAP.     

The Awkward Moments Test: A Naturalistic Measure of Social Understanding in Autism

Details are given of a new advanced theory of mind task, developed to approximate the demands of real-life mentalizing in able individuals with autism. Excerpts of films showing characters in social situations were presented, with participants required to answer questions on characters' mental states and on control, nonsocial questions. When compared with control participants, adults with high-functioning autism and Asperger syndrome were most impaired in their ability to answer the questions requiring mind-reading ability. Although the present findings have implications for task modification, such naturalistic, dynamic stimuli are held to offer an important means of studying subtle difficulties in mentalistic understanding.     

Can verbalization remedy the theory of mind deficit in schizophrenia?

Several studies provide convincing evidence of a specific deficit in the theory of mind (ToM) in some patients with schizophrenia. This ToM deficit consists of an inability to attribute relevant mental states to others, and studies suggest it has to be regarded as functional and remediable through the use of reinforced context processing. To investigate this, the present study compares the performances of 25 schizophrenics and 25 matched controls in a task exploring ToM before and after the introduction of verbal material into the task, initially conceived as nonverbal. All the controls and half of the schizophrenic subjects who did not initially perform at the best level remediated with verbalization, while 9 of the schizophrenics exhibited no remediation. These poor performers are characterized by a longer duration of illness. The cognitive plasticity and the characteristics of patients who do/do not remediate are discussed in the light of findings obtained with the Wisconsin Card Sorting Test. The clinical implication of these results is important since they suggest that some patients would benefit from cognitive rehabilitation in terms of their ability to attribute relevant mental states to others.     

Understanding of Thought Bubbles as Mental Representations in Children with Autism: Implications for Theory of Mind

Standard false belief tasks indicate that normally developing children do not fully develop a theory of mind until the age of 4 years and that children with autism have an impaired theory of mind. Recent evidence, however, suggests that children as young as 3 years of age understand that thought bubbles depict mental representations and that these can be false. Twelve normally developing children and 11 children with autism were tested on a standard false belief task and a number of tasks that employed thought bubbles to represent mental states. While the majority of normally developing children and children with autism failed the standard false belief task, they understood that (i) thought bubbles represent thought, (ii) thought bubbles can be used to infer an unknown reality, (iii) thoughts can be different, and (iv) thoughts can be false. These results indicate that autistic children with a relatively low verbal mental age may be capable of understanding mental representations.     

Hello and Goodbye: A Study of Social Engagement in Autism

We videotaped 24 children, adolescents, and young adults with autism, individually matched for chronological age and verbal mental age with 24 nonautistic persons with mental retardation, for their spontaneous and prompted greetings and farewells towards an unfamiliar adult. Compared with control subjects, those with autism were less likely to offer spontaneous verbal and nonverbal gestures of greeting and farewell, and were less likely to establish eye contact even when they were offered a greeting. There were also fewer autistic subjects who smiled, or who waved goodbye. Results corresponded with raters' subjective judgments of participants' interpersonal engagement with the stranger. One interpretation of the findings is that they reflect a relative lack of intersubjective engagement by autistic individuals.     

Adaptive behaviour and theory of mind in autism

The Vineland Adaptive Behavior Scales are used to assess the real life competence of adolescents and adults with autism in France. Real life adaptation is compared with performance on social cognitive tasks, involving the attribution of mental states, and with subjects’ age and ability. New scales are used to contrast real life behaviours which appear to require the ability to attribute mental states with those behaviours which are possible without this ability. Subjects with autism who passed social cognitive tasks showed higher intellectual ability, as well as being older. In addition, they were better than subjects who failed tasks in terms of those social and maladaptive behaviours involving understanding minds. However, when their verbal ability was taken into account, these specific differences were no longer significant. These results are discussed in relation to a parallel study carried out in England, where essentially the same results were obtained. Both studies suggest that the stereotype of the aloof, socially indifferent autistic child does not reflect the sociability of adolescents and young adults with autism.     

Making sense of another mind: the role of the right temporo-parietal junction

Human adults conceive of one another as beings with minds, and attribute to one another mental states like perceptions, desires and beliefs. That is, we understand other people using a 'Theory of Mind'. The current study investigated the contributions of four brain regions to Theory of Mind reasoning. The right temporo-parietal junction (RTPJ) was recruited selectively for the attribution of mental states, and not for other socially relevant facts about a person, and the response of the RTPJ was modulated by the congruence or incongruence of multiple relevant facts about the target's mind. None of the other three brain regions commonly implicated in Theory of Mind reasoning--the left temporo-parietal junction (LTPJ), posterior cingulate (PC) and medial prefrontal cortex (MPFC)--showed an equally selective profile of response. The implications of these results for an alternative theory of reasoning about other minds--Simulation Theory--are discussed.     

Failure to read motor intentions from gaze in children with autism

A core feature of autism is the abnormal use of gaze to attribute mental states to others, and thus to predict others' behaviour. An untested idea is whether this dysfunction is confined to mental states having a propositional content, such as beliefs and desire or extends to motor intentional states which allow one to make inferences about the actions of others. This study used kinematics to examine the ability to use gaze to inform one about the motor states of another in normal and autistic children. In each trial two participants, a model and an observer, were seated facing each other at a table. In three experimental blocks the model was requested to grasp a stimulus, to gaze towards the same stimulus, and to gaze away from the stimulus without performing any action. The task for the observer was to grasp the stimulus after having watched the model perform her task. We observed that normal children showed facilitation effects in terms of movement speed following the observation of the model grasping or simply gazing at the object. In contrast, autistic children did not show any evidence of facilitation in these conditions. Neither normal nor autistic children showed evidence of facilitation when the model's gaze was not directed towards the stimulus. These findings demonstrate that, in contrast to normal children, children with autism fail to use information from the model's action or gaze to plan their subsequent action, and that in autism the inability to use of another person's gaze produces a lack of understanding of the motor intention of others.     

Cognitive, language and social-cognitive skills of individuals with fragile X syndrome with and without autism

Background It is not known whether those with co‐morbid fragile X syndrome (FXS) and autism represent a distinct subtype of FXS; whether the especially severe cognitive delays seen in studies of young children with co‐morbid FXS and autism compared with those with only FXS continue into adolescence and young adulthood; and whether autism in those with FXS is ‘true autism’, i.e. reflects the same underlying problems as idiopathic autism. Method We compared the non‐verbal IQ of adolescents and young adults with co‐morbid FXS and autism (n = 10) with those with only FXS (n = 44). We then created a subsample of those with FXS only, matched on non‐verbal IQ, mental age and gender (n = 21) to the subsample of those with co‐morbid FXS and autism. We compared the two groups on measures of expressive language, receptive language (lexical, grammatical morphology and syntactic patterns), and a theory of mind task. Results Those with co‐morbid FXS and autism had lower non‐verbal IQs than those with only FXS. The participants with co‐morbid FXS and autism did not perform as well as the cognitive ability‐ and gender‐matched participants with only FXS on the three measures of receptive language or the theory of mind task; there were no differences on the expressive language measure. Conclusions Our findings support the notion that those with co‐morbid FXS and autism represent a distinct subtype of FXS, with more impairment in receptive language and theory of mind even when controlling for their lower non‐verbal IQ relative to those with only FXS. The greater cognitive impairments observed in those with co‐morbid FXS and autism continues into adolescence and young adulthood; and the autism seen in those with FXS appears to be the same as idiopathic autism.     

Elaboration of a rehabilitation method based on a pathogenetic hypothesis of "theory of mind" impairment in schizophrenia

"Theory of mind" skills have repeatedly been shown to be impaired in schizophrenic patients. The purpose of this paper is to develop a therapeutic intervention targeting schizophrenic patients' abilities to attribute mental states to others. This preliminary study tried to test the hypothesis that this kind of intervention should improve patients' communication abilities; we also wondered if this would have a positive impact on their more general psychopathology. Eight chronic schizophrenic patients were asked to analyse video scenes (showing interactions between two or more persons), with particular attention being paid to the characters' mental states. Their clinical assessments (general clinical symptoms, communication, and the ability to attribute intentions to others, rated before and after two training sessions, over a one-week period) were compared with those of a control group of six chronic schizophrenic patients. The results support our hypothesis of a possible improvement of patients' communication disorders and an improvement of their abilities to attribute intentions to others. The more general psychopathology ratings, however, remained unchanged. Although these results need further development and confirmation, they suggest a possible promising approach for psychosocial rehabilitation therapies based on "theory of mind" skills.     

The effect of semantic and emotional context on written recall for verbal language in high functioning adults with autism spectrum disorder

OBJECTIVE—Several deficits havebeen proposed to account for cognitive impairment in autism includingan inability to comprehend the perspectives of others ("theory ofmind"), an inability to process emotional information, and difficultydrawing together diverse information in context ("centralcoherence"). Because context (central coherence) and emotion caninfluence memory, a study was designed to show if autism spectrumdisorder was associated with impaired utilisation of context andemotion in recall; and if impairments in theory of mind processingwould influence recall in autism spectrum disorder.
METHODS—Ten high functioning subjects with autismspectrum disorder and 13 age and IQ matched controls were tested usingrecall tests. In the first coherence memory test, subjects listened toa series of word lists that were in varying degrees of syntactic andsemantic (coherent) order and were asked to recall the words. In thesecond coherence memory test, subjects listened to stories consisting of sentences that were, or were not, in logical (coherent) order. Inthe emotional memory test, the subjects listened to sentences thatwere highly emotional or non-emotional. In the theory of mind test, thesubjects listened to stories requiring varying levels of understandingof the perspectives of others.
RESULTS—There were no significant differencesbetween groups in recall of coherent versus incoherent word lists, norwas there a significant difference between groups in recall of coherentversus incoherent stories. However, the control subjects recalled moreof the emotional than non-emotional sentences, whereas the autismspectrum disorder group did not show such a difference. No significantdifference existed in recall of stories requiring varying levels ofunderstanding of the perspectives of others among subjects with autismspectrum disorder, and subjects with autism spectrum disorder did notdiffer from control subjects in the influence of theory of mind content on story recall.
CONCLUSION—The study shows that memoryin high functioning adults with autism spectrum disorder is facilitatedby emotional content to a lesser degree than it is facilitated bycoherence. Therefore, impairments in emotional processing cannot beconsidered as simply an effect of the "weak central coherence"theory in autism spectrum disorder. Whereas the reasons for thisemotional deficit are unknown, evidence of abnormalities of the limbicstructures in autism spectrum disorder may provide an anatomical explanation.

     

Matching Procedures in Autism Research: Evidence from Meta-Analytic Studies

In this paper, we summarize some of our findings from a series of three meta-analyses and discuss their implications for autism research. In the first meta-analysis, we examined studies addressing the theory of mind hypothesis in autism. This analysis revealed that theory of mind disabilities are not unique to autism, although what may be unique is the severity of the dysfunction in this group. Variables such as the chronological and mental age of the participants, and the matching procedures that the researchers employed, were found to be significant moderator variables. In the next two meta-analyses, data regarding siblings and parents of individuals with autism were analyzed. Type of comparison group (e.g., siblings or parents of individuals with Down syndrome or learning disabilities) and type of outcome measure (cognitive, psychiatric, language) were found to be important moderator variables. Furthermore, method of assessing the psychiatric difficulties (e.g., self-report, clinical measures) was found to be a moderator variable in parents' meta-analysis. Suggestions for future research are discussed, highlighting variables such as type of comparison group, matching procedures, chronological and mental ages, gender, and birth order.     

What's domain-specific about theory of mind?

Twenty years ago, Baron-Cohen and colleagues argued that autistic performance on false belief tests was explained by a deficit in metarepresentation. Subsequent research moved from the view that the mind has a domain-general capacity for metarepresentation to the view that the mind has a domain-specific mechanism for metarepresentation of mental states per se, i.e., the theory of mind mechanism (ToMM). We argue that 20 years of data collection in lesion patients and children with autism supports a more parsimonious view closer to that of the 1985 paper. Lower-level domain-specific mechanisms--e.g., tracking gaze, joint attention--interacting with higher-level domain-general mechanisms for metarepresentation, recursion, and executive function can account for observed patterns of deficits in both autism and neurological patients. The performance of children with autism or orbitofrontal patients on ToM tests can be explained more parsimoniously by their deficits in lower-level domain-specific mechanisms for processing social information. Without proper inputs, the intact capacity for metarepresentation by itself cannot make correct ToM inferences. Children with autism have no impairment in false photograph tests because their metarepresentational capacity is intact and they have no impairment in inputs required for such tests. TPJ patients have equivalent deficits on ToM and non-ToM metarepresentational tasks, consistent with a failure in domain-general processing. If deficits on ToM tasks can result from deficits in low-level input systems or in higher-level domain-general capacities, postulating a separate ToM mechanism may have been an unnecessary theoretical move.     

Dissociation of cognitive from affective components of theory of mind in schizophrenia

Patients suffering from schizophrenia show impaired emotional and social behavior, such as misinterpretation of social situations and lack of theory of mind. However, there is conflicting evidence regarding their ability to perform on theory of mind tasks. Based on previous findings with patients suffering from prefrontal damage, the present study suggests that the behavioral deficit of schizophrenic patients may be due to impaired 'affective theory of mind' abilities, rather than to a general impairment in theory of mind. To test this hypothesis we assessed the ability of 22 schizophrenic patients and 55 age-matched healthy controls, to judge first and second order affective vs. cognitive mental state attribution, based on eye gaze. The relationships between negative and positive symptoms of schizophrenia, and affective and cognitive theory of mind were also assessed. Results indicated that while healthy controls made fewer errors on affective as compared to cognitive theory of mind conditions, schizophrenic patients showed a less prominent trend. Although the pattern of reaction time did not differ significantly between groups, the patients made significantly more errors in the affective conditions, as compared to controls. Furthermore, correlation analysis indicated that impaired affective theory of mind in these patients correlated with their level of negative symptoms. These results indicate that individuals with high level of negative symptoms of schizophrenia may demonstrate selective impairment in their ability to attribute affective mental states. These findings offer new insight into the affective facets of social behavior that may underlie the profound behavioral disturbances observed in schizophrenia.     

Theory of own mind and autobiographical memory in adults with ASD

While there is solid evidence of other-related theory of mind (ToM) deficits in autism, there is less research addressing self-related ToM impairments. To date, relations between self-related ToM and other cognitive skills related to representing own mental states such as autobiographical memory have scarcely been investigated. Thus, the purpose of this study was to investigate the differential relations of self-and other-related theory of mind skills and autobiographical memory in n = 20 adults with Autism Spectrum Disorder and n = 20 matched controls using standardized measures. The overall results indicated a specific relation between recalled episodic autobiographical memories on the episodic and semantic autobiographical memory interview and the performance on the mind-mindedness for oneself task in adults with ASD, which proved to be largely independent of verbal and nonverbal IQ.     

A psychological approach to understanding the social and language impairments in autism

This paper surveys current research on the social and communicative impairments in autism. In diagnostic schemes, the criteria for identifying autism in these domains include overlapping features. One approach to interpreting this overlap is to consider that social and communicative impairments reflect the same underlying cognitive deficit, referred to as the 'theory of mind' hypothesis of autism. On this view autism involves primary difficulties in identifying mental states in other people, and in interpreting behavior and action in relation to a person's mental state. Studies on the relationship between social behavior, communicative functioning, and theory of mind in children with autism are reviewed, emphasizing the connections between these areas of impairment that are central to the definition of the autistic syndrome.     

A comparative study of attachment behavior in young children with autism or other psychiatric disorders

The present study examined attachment behavior in children with autism and children with other developmental or psychiatric disorders. The groups were matched on chronological and mental age, IQ, and socioeconomic status. When a modified Strange Situation paradigm was used, no group differences were found in proximity seeking, contact maintenance, proximity avoidance, or contact resistance; the groups also did not differ in their overall security ratings. Attachment security was related to several developmental variables in the autistic group but not in the nonautistic comparison group. This suggests that attachment formation may involve different processes in autistic children than in nonautistic children of equivalent intellectual level.     

Effects of age and IQ on adaptive behavior domains for children with autism

Researchers have examined adaptive behavior in autism, but few studies have looked for different patterns of adaptive skills according to age and intelligence. Domain scores from the Vineland Adaptive Behavior Scale (VABS) were compared in relation to age and Performance IQ for 72 children and adolescents with autism and 37 nonautistic children and adolescents with mental retardation. Age and IQ were positively related to each of the Vineland domains. Children with autism had lower scores in the socialization domain. An interaction was present between Performance IQ and group: With increasing IQ, children with autism showed smaller increases in social functioning than children with mental retardation. A similar trend was present for daily living skills. Results suggest that (a) the relationship between the two groups' adaptive behavior profiles is stable from preschool age through adolescence, and (b) increasing IQ is associated with less of an increase in certain adaptive skills for children with autism.