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.

References:

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