Anemone's Research Emporium

A Brief History of Theory of Mind (ToM)

Part 3: Autism and ToM

Anemone Cerridwen
April 17, 2009

Here's some simple math:

new test du jour + new diagnosis du jour = relationship between new test and new diagnosis

. . . or at least an attempt to check it out. Why? Because it's there!

Autistic subjects fail ToM tests spectacularly compared to same age controls

In 1985, Simon Baron-Cohen, Alan M. Leslie and Uta Frith took a variation of Wimmer and Perner's ToM test (the theory-du-jour) and applied it to twenty autistic children (the diagnosis-du-jour), fourteen children with Down Syndrome (to control for mental retardation) and a set of twenty-seven controls (normal preschool children). The test they used involved two dolls, Sally and Ann, one of whom places a marble in one location, then leaves the room, after which the other doll moves the marble. The children were then asked where the first doll would look for the marble upon returning. Twelve of the Down Syndrome subjects and twenty-three of the normal subjects answered correctly, but only four of the autistic subjects passed, so obviously there was a significant difference between the autistic group and the other two groups. The autistic subjects who got it wrong tended to point to where the object had been moved to, even though the returning doll had no idea it would have been moved. The researchers assumed that this meant the autistic kids couldn't tell the difference between what they knew and what the doll would have known: that the autistic children lacked theory of mind, at least for false beliefs.

This study was confirmed and expanded on by lots of later studies. And even though research demonstrated that there was a delay on ToM in autistic children (e.g. Baron-Cohen, 1989) rather than a complete lack of ToM in all autistic people, it became widely known that autistic people lack ToM.

Some double standards

Overall, with some exceptions, researchers tended to see failure at ToM tests as proof that autistic people lack ToM (and generally assumed that this is what probably causes our communication deficits), and success as something to be ignored or explained away.

One way they did this was concentrate their experiments on kids. Autistic kids do pass these tests at later ages compared to controls, but we seem to catch up at some point, at least those of us who reach a high enough verbal mental age (Happé, 1995). If you looked at ToM adults, we might not do so bad. Of course, until recently there was a tendency to think of autism as something kids have, so it's not suprising that they tested their theory on children rather than adults, even though by this time there should have been some adults to test. They then used their results and applied them to autistic people in general, instead of to autistic people in this age range only. That was the no-no.

Another way was to come up with harder tests when the standard false belief tests were too easy for some autistic subjects, for example the strange stories test (Happé, 1994), reading the mind in the eyes (Baron-Cohen et al., 1997), the faux pas test (Baron-Cohen et al., 1999), and reading the mind in the voice (Rutherford et al., 2002). All of these tests are harder to pass and so can be applied to older autistic individuals who look too good on the easier tests. It's all about what we can't do, after all, rather than what autism is. So they say we can't pass test 1, so we don't have ToM, but then when we're old enough and sophisticated enough to pass test 1, they come up with a harder test, test 2, which is hard enough for us to have problems on (though I bet a lot of us would eventually pass it, too, just at later ages), proving yet again that we don't have ToM. I don't remember anyone coming up with harder tests to prove normal kids don't really have ToM at age 5 or 6, when they start consistently passing the traditional false beliefs test. As far as I know, that was good enough for them. Why not for us? Because researchers were keen to prove we didn't have it. Once they caught a scent, they didn't want to leave off the chase.

But at the same time, a lot of autistic subjects are generally not doing so well at ToM tasks that look pretty simple from where I'm sitting. So something is going on. What is it?

Other possible explanations

Difficulties with testing environment

Even though researchers knew that

"the main symptom [of autism], which can be reliably identified, is impairment in verbal and nonverbal communication" [Baron-Cohen et al., 1985, page 37]

they still put autistic children in a situation with high verbal demands, and used it to test intellectual skills. They did use control subjects with specific language impairments (SLI) in some experiments (e.g. Leslie and Frith, 1988, Perner et al., 1989), though even SLI subjects have problems at times (see Gernsbacher and Frymiare, 2005, for a lovely summary of language versus ToM results in many demographic groups), but even when SLI'ers do fine, the language impairments that they experience may not bear any relation to the language or communication impairments that autistic people have to deal with.

Communication demands of the tests may be too difficult, even with equality in language ability between autistic subjects and the control groups (which they did try to control for at times). I have regular problems communicating and participating in conversations, and I scored in the 99th percentile on the GRE verbal a while back. There is more to communication than language, something many people seem to forget.

Lack of social experience

Another possibility is that communication deficits are interfering with practicing and learning ToM in the first place. Researchers have found that it doesn't make any difference whether you use dolls or drawings or live people in the test, at least for non-autistic subjects, and that it doesn't make any difference if you talk about what people "know" or "believe" or "will say" (Wellman et al., 2001). But having more siblings does increase ToM ability (e.g. Cassidy et al., 2005, Perner et al., 1994), as does verbal/language abilities in non-autistic (Milligan et al., 2007) and autistic subjects (Eisenmajer and Prior, 1991, Happé, 1995, Steele et al. 2003). And late-signing in deaf children can cause ToM delays, too (Peterson, 2002, Schick et al., 2007) - it's not just autism. In other words, autistic people may be delayed (not lacking, delayed) on ToM tasks because they haven't had as much practice with the stuff in real life as other people have, possibly because, even with a ton of siblings, they have a hard time joining in socially. In other words, autistic people are relatively socially inexperienced. Autism does that to people.

Theory of Mind versus communication deficits

I'm not really sure why, but for some reason researchers assumed that there is a basic cognitive deficit in autism, that causes the communication deficit. (Either that or an affective (emotional) deficit.) I've never seen any reason to believe so, myself. It seems to me that communication is communication, not cognition or affect (emotion). It's possible that they were confused because autistic people continue to be autistic even when we acquire language, but communication is more than language and speech, as I keep saying.

Personally, I think researching ToM quickly became a waste of time. So we don't do as well as others do at the same early age. So what? Does knowing this make any difference in outcome? No. Does it help people see us better? No. Worse, actually, since it focusses on non-universal intellectual deficits rather than universal deficits. A non-universal deficit is not going to be a core deficit. Once it became obvious that at least some autistic people pass at least some ToM tests at least some of the time, it became a dead end.

And there were other things that needed (and still need) researching more. Deficits common to all autists at all ages, including, possibly, non-language, non-cognitive communication deficits.

Part 4: ToM and bigotry

References

Simon Baron-Cohen, 1989. The autistic child's theory of mind: a case of specific developmental delay. Journal of Child Psychology and Psychiatry 30(2): 285-297.

Simon Baron-Cohen, Alan M. Leslie and Uta Frith, 1985. Does the autistic child have a "theory of mind"? Cognition 21: 37-46.

Simon Baron-Cohen, Michelle O'Riordan, Valerie Stone, Rosie Jones and Kate Plaisted, 1999. Recognition of faux pas by normally developing children and children with Asperger Syndrome or high-functioning autism. Journal of Autism and Developmental Disorders 29(5):407-418.

Simon Baron-Cohen, Sally Wheelwright and Therese Jolliffe, 1997. Is there a "language of the eyes"? Evidence from normal adults, and adults with autism or Asperger Syndrome. Visual Cognition 4(3):311-331.

Kimberly Wright Cassidy, Deborah Shaw Fineberg, Kimberly Brown and Alexis Perkins, 2005. Theory of mind may be contagious, but you don't catch it from your twin. Child Development 76(1):97-106.

Richard Eisenmajer and Margot Prior, 1991. Cognitive linguistic correlates of 'theory of mind' ability in autistic children. British Journal of Developmental Psychology 9:351-364.

Morton Ann Gernsbacher and Jennifer L. Frymiare, 2005. Does the autistic brain lack core modules? Journal of Developmental and Learning Disorders 9:3-16. Retrieved January 10, 2009 from http://psych.wisc.edu/gradstudies/gradstudents/stevenson/Gernsbacher_JDLD_2005.pdf

Francesca G. E. Happé, 1994. An advanced test of theory of mind: understanding of story characters' thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. Journal of Autism and Developmental Disorders 24(2):129-154.

Francesca G.E. Happé, 1995. The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development 66:843-855.

Alan M. Leslie and Uta Frith, 1988. Autistic children's understanding of seeing, knowing and believing. British Journal of Developmental Psychology 6:315-324.

Karen Milligan, Janet Wilde Astington and Lisa Ain Dack, 2007. Language and theory of mind: meta-analysis of the relation between language ability and false-belief understanding. Child Development 78(2):622-646.

Josef Perner, Uta Frith, Alan M. Leslie and Susan R. Leekam, 1989. Exploration of the autistic child's theory of mind: knowledge, belief, and communication. Child Development 60:689-700.

Josef Perner, Ted Ruffman and Susan R. Leekam, 1994. Theory of mind is contagious: you catch it from your sibs. Child Development, 65:1228-1238.

Candida C. Peterson, 2002. Drawing insight from pictures: the development of concepts of false drawing and false belief in children with deafness, normal hearing, and autism. Child Development 73(5):1442-1459.

M. D. Rutherford, Simon Baron-Cohen and Sally Wheelwright, 2002. Reading the mind in the voice: a study with normal adults and adults with Asperger Syndrome and high functioning autism. Journal of Autism and Developmental Disorders 32(3):189-194.

Brenda Schick, Peter de Villiers, Jill de Villers and Robert Hoffmeister, 2007. Language and theory of mind: a study of deaf children. Child Development 78(2):376-396.

Shelly Steele, Robert M. Joseph and Helen Tager-Flusberg, 2003. Brief Report: Developmental change in theory of mind abilities in children with autism. Journal of Autism and Developmental Disorders 33(4):461-467.

Henry M. Wellman, David Cross and Julanne Watson, 2001. Meta-analysis of theory-of-mind development: the truth about false belief. Child Development 72(3):655-684.

. . . and some alternate points of view from the autism crowd

Carolien Rieffe, Mark Meerum Terwogt and Lex Stockmann, 2000. Understanding atypical emotions among children with autism. Journal of Autism and Developmental Disorders 30(3):195-203.

Malinda Carpenter, Bruce F. Pennington and Sally J. Rogers, 2001. Understanding of others' intentions in children with autism. Journal of Autism and Developmental Disorders 31(6):589-599.