Theory of Mind and Its Significance in Children with Autism
http://proprium.psychoadaptation.com/theory_of_mind.pdf
Proprium Journal of Psychology, Vol. 2, 2008
Theory of Mind and Its Significance in Children with Autism
Staci Young
1, B.A.LaSalle University
Abstract
Objectives
: Theory of mind may be one of the most studied topics in autism research today.Children with autism display behaviors that may appear odd due to their impairments in
communication and language, in social situations, and may exhibit stereotyped or repetitive
behaviors and/or interests. These children typically also have a deficit in theory of mind or the
ability to understand the mental states of others.
Results: Research currently focuses onpotential relationships between theory of mind and social experiences, language development,
and other cognitive processes. Most studies have confirmed a relationship between theory of
mind deficits and impairment in one of the above areas, and have implied the importance of early
language and communication skills development, mental state discourse, and training programs
in theory of mind development.
Conclusions: The implications of these studies may provide avaluable stepping stone for the development of early intervention programs specializing in these
areas.
Introduction
Autistic Disorder may be one of the fastest growing diagnoses in young children today.
Recent statistics from the Center for Disease Control and Prevention suggests a prevalence rate
of nearly 1 in 150 (previously 1 in 250) children diagnosed with an Autism Spectrum Disorder
(Center for Disease Control and Prevention; Kabot, Masi, & Segal, 2003). Despite this startling
statistic, researchers have yet to agree on the causal factors of autism. According to Kabot et al.
(2003), autism appears to be due to a dysfunction in the central nervous system. Although there
is little agreement regarding a single cause, researchers agree that autism can be considered any
one of three types of disorders: a neurological disorder, a psychological disorder affecting
cognitive, emotional, and behavioral development, or a disorder of social relationships (Kabot et
al., 2003).
Children with Autistic Disorder have several defining characteristics, including
impairment in social interactions, impairment in communication, and stereotyped or repetitive
patterns of behaviors and interests (American Psychiatric Association, 2000). Such deficits and
behaviors cause these children to appear especially odd when they encounter social situations.
One such peculiarity found among children with autism is an apparent lack of theory of mind,
which is one of the most popular topics in current autism research (Begeer, Rieffe, Terwogt, &
Stockmann, 2003; Carpenter, Pennington, & Rogers, 2001; Fisher & Happe, 2005; Jarrold,
Butler, Cottington, & Jimenez, 2000; Kerr & Durkin, 2004; Kinderman, Dunbar, & Bentall,
1998; Kleinman, Marciano, & Ault, 2001; Muris et al., 1999; Pellicano, 2007; Sicotte &
Stemburger, 1999; Steele, Joseph, & Tager-Flusberg, 2003; Symons, 2004). Most of the current
research concerning theory of mind is devoted to the cognitive differences between children with
autism and typically developing children.
Theory of Mind and Its Significance in Autistic Disorder
Theory of mind is described as the ability to understand or speculate about the way others
think and believe, including the ability to anticipate others’ behavior (Carpenter et al., 2001;
Crain, 2005; Fisher & Happe, 2005; Muris et al., 1999). Therefore, children with autism have
difficulty understanding that others have thoughts and emotions different from their own. Some
researchers suggest that theory of mind is necessary both for understanding one’s social
environment and for the ability to engage in socially appropriate behavior (Kinderman et al.,
1998; Muris et al., 1999). Theory of mind deficits in children with autism may be a causal factor
in these individuals’ social impairments (Kinderman et al., 1998; Kleinman et al., 2001; Muris et
al., 1999; Surian, 1997; Yirmiya, Erel, Shaked, & Solomonica-Levi, 1998).
In most research, a child who is believed to have a theory of mind deficit is asked to
complete a false belief task. The false belief task is the most frequently used instrument in
current theory of mind research and tests an individual’s comprehension of another’s false belief
(Muris et al., 1999). A false belief is simply an individual’s wrong belief about others’ thoughts
(Muris et al., 1999). In a false belief task, the child is asked a series of questions designed to
predict whether the child can distinguish between newfound knowledge of a stimulus and
previous thoughts about the stimulus of interest (Muris et al., 1999; Symons, 2004).
One popular false belief task called the Smarties test involves a child being presented a
box with a picture of candy displayed on its lid (Crain, 2005; Muris et al., 1999). When the child
opens the box, he or she discovers that the box instead holds crayons or pencils (Crain, 2005;
Muris et al., 1999). Flavell et al. found that if this child is asked whether another child who has
not seen the contents of the box will know that the box contains crayons rather than candy, the
child with impaired theory of mind will assume that the other child shares his knowledge of the
unexpected contents of the box (Crain, 2005; Muris et al., 1999; Symons, 2004). Thus, the child
will expect another child to predict that the box holds crayons. The failure of this task illustrates
an inability to understand the separation of self and others.
Flavell et al. suggested that the knowledge of the differentiation between self and others
typically does not develop until a child is around the age of four or five years (Crain, 2005). For
a child to exhibit theory of mind, he or she must be able to correctly complete the above false
belief task by assuming that the other child will not share knowledge of the box’s true contents
and predicting that the child will state the box contains candy (Crain, 2005). After the successful
completion of the false belief task, a child should be able to understand that the self is a mental
agent whose thoughts and beliefs can change over time and are distinct from the self of another
individual (Symons, 2004).
The development of theory of mind may have first been suggested through Vygotsky’s
theory of internalization (Symons, 2004). Internalization is the process by which a child’s
reasoning about mental states becomes internalized through participation in interpersonal
dialogue about self and others’ thoughts and emotions (Symons, 2004). This interpersonal
dialogue can be witnessed through social and pretend play (Symons, 2004). Vygotsky expected
the child to first speak aloud, expressing her and others’ thoughts and emotions in an egocentric
fashion before she is able to speak internally and thus differentiate between self and other’s
thoughts and emotions (Crain, 2005). Similarly, Baldwin believed that a child’s social self
emerges when he or she discovers that others also think of themselves as “me” and that they
have different experiences than the child’s own (Symons, 2004).
Theory of Mind: Social Implications
The development of theory of mind can be influenced by social means in addition to
maturational processes. Examination of Bowlby’s attachment theory and theory of the working
model suggests that the early caregiver relationship with the child can shape the child’s
expectations of others’ behavior, as the construction of mental representations of the surrounding
social world is a natural consequence of the early caregiver relationship (Symons, 2004).
Therefore, even from the very beginning, a child’s later theory of mind development can be
influenced externally. Vygotsky’s theories may imply that children learn about their social
world by directly or indirectly listening to adults or older children discussing events around
them, all while internalizing rules about the functioning world (Symons, 2004). Meins and
others similarly believe that children learn to internalize representations of self and others
through conversations with their caregivers about emotions, yet others believe caregiver
attachment is unrelated to internalization (Symons, 2004).
According to Bruner, speech and language may also greatly influence a child’s internal
speech as a potential source of information about the social world, which the child can then
internalize into his or her own thoughts and feelings about the world (Symons, 2004). Even
Piaget, who rarely discussed development from a social context, suggested that the
understanding of self in relation to others may be affected by social and cultural contexts, with
social contact contributing to the development of consciousness of self (Symons, 2004). Hence,
early communication with other more mature individuals about thoughts and feelings can be
highly influential in the development of theory of mind.
Due to the nature of Autistic Disorder, one might conclude that as children with autism
have severe social and communication impairments, they may not be able to as easily internalize
such discourse about the mental states of others or even themselves. Children with autism
frequently have difficulty engaging in appropriate interactions with others and in more severe
cases remain unable to communicate their basic needs to caregivers. Thus, they most likely will
not be observed engaging in any kind of conversation with another individual about their
thoughts and feelings. Without engaging in this discourse, they may have a decreased ability to
complete the process of internalization and may consequently be unable to develop theory of
mind at the same rate as their typically developing peers.
Most of the current research focuses on the relationship between theory of mind deficits
and the social experiences and cognitive processes of children with Pervasive Developmental
Disorders such as Autistic Disorder and Pervasive Developmental Disorder - Not Otherwise
Specified (PDD-NOS). Researchers have designed many different tasks testing theory of mind
(i.e., false belief tasks, brain function tasks) and have completed longitudinal studies in order to
better understand the relationship between theory of mind and autism. Thus far, the research has
found significant evidence of a strong relationship between Autistic Disorder and theory of mind
deficits (Begeer et al., 2003, Fisher & Happe, 2005; Kerr & Durkin, 2004; Kinderman et al.,
1998; Kleinman et al, 2001; Morgan, Maybery, & Durkin, 2003; Muris et al., 1999; Oberman &
Ramachandran, 2007; Pellicano, 2007; Sicotte & Stemburger, 2007; Steele et al., 2003; Yirmiya
et al., 1998).
As Symons (2004) discussed, theory of mind deficits may be inversely related to
language development and mental state discourse with caregivers. Symons argued that a child’s
early communication about the cognitions and emotions of others is critical to the development
of theory of mind in addition to the development of social understanding (2004). Similarly,
Symons suggested that the more a child participates in and exposure to conversations about the
mental states of self and others, the more the child learns about these states (2004). This in turn
leads to the acquisition of theory of mind as well as improved false belief task performance
(Symons, 2004).
Other studies support Symons’s view by demonstrating the significance of language
development and mental state discourse (Hadwin, Baron-Cohen, Howlin, & Hill, 1997). One
such longitudinal study examined the developmental changes in theory of mind over one year’s
time in children with autism aged 4-14 years (Steel et al., 2003). Children who improved their
theory of mind ability were also higher in language development (Steele et al., 2003). The
researchers suggested that the participants’ improved theory of mind abilities were directly
related to their higher levels of language development at the completion of the study (Steele et
al., 2003). Although this study did not directly discuss the implications of increased mental state
discourse, it may be interesting to discover the relationship between language development and
mental state discourse. Perhaps the more a child participates in mental state discourse, the more
he or she develops language skills, or vice versa; it may also be worth considering that children
with autism already have impaired language and communication. Thus, as children with autism
typically also have impaired theory of mind, they probably will improve their theory of mind
abilities as their language skills develop.
Theory of Mind Research: Implications for Children with Autism
The false belief task has been used widely in theory of mind research, as one might
expect given its frequent mention in the literature and textbooks (e.g., Crain, 2005; Muris et al.,
1999; Symons 2004). Although researchers have used the false belief task for several different
research objectives, most have found that children with autism do in fact perform more poorly
than typically developing children (Begeer et al., 2003; Kerr & Durkin, 2004; Sicotte &
Stemburger, 1999). Some research has even found differences in false belief task performance
between high-functioning children with PDD-NOS and children with autism (Begeer et al.,
2003). In fact, the results of this study support other researchers who believe that social and
communicative factors play an important role in a child’s performance on theory of mind tasks
such as the false belief task (Begeer et al. 2003; Hadwin et al., 1997; Steele et al., 2003; Symons,
2004). However, children diagnosed with PDD-NOS may be considered to have a less severe
form of Autistic Disorder as their symptoms do not meet all of the criteria for a more specific
Pervasive Developmental Disorder (APA, 2000). These children with PDD-NOS may then have
further developed language and social communicative skills. According to several researchers,
they may be more able to complete the false belief task as higher performance on this task
suggests a child’s higher language development as well as greater participation in mental state
discourse (Begeer et al., 2003; Hadwin et al., 1997; Sicotte & Stemburger, 1999; Steele et al.,
2003; Symons, 2004).
In order to further examine the differences in 3-year-old children’s understanding of
mental states, Kerr and Durkin (2004) developed a study which used both a standard false belief
task and several other tasks designed to gauge a child’s understanding of mental states.
According to Kerr and Durkin, typically developing 3-year-old children may be able to
understand that “thought bubbles” represent thoughts in others and while they do in fact
accurately represent an individual’s thoughts, these thought bubbles may at times be false or
misleading (2004). This finding supports the idea that although most 3-year-old children cannot
exhibit theory of mind reasoning, they still may be able to understand some aspects of mental
states (Kerr & Durkin, 2004). Interestingly, Kerr and Durkin found that 3-year-old children with
autism are able to understand the concept of thought bubbles suggesting that these children may
also have some awareness of mental states (2004). Thus, the standard false belief task may not
always be extensive enough to effectively test for evidence of theory of mind or any
understanding of mental states in young children.
Another potential problem with the frequent use of false belief tasks in testing theory of
mind in both typically developing children and children with Pervasive Developmental Disorders
is the age at which a child is expected to be able to successfully complete the task (Kerr &
Durkin, 2004). For typically developing children, the task is generally successfully completed
around the age of 4 or 5 years (Kerr & Durkin, 2004; Symons, 2004). However, since children
typically present symptoms of a Pervasive Developmental Disorder by age 3, the differences
between these children and typically developing children’s understanding of mental states may
be unclear at this point (APA, 2000).
Another issue needing further study is how to assess theory of mind deficits in older
children. The false belief task frequently used for preschool-aged children may not be
appropriate for older children. Several researchers have developed additional tasks more
appropriate for older children, used to study theory of mind in both typically developing children
and children with autism. Muris et al. attempted to test the validity of one such test, called the
Theory-of-Mind test (TOM test), developed by Steememan in 1994 (1999). This test interviews
children between the ages of 5 and 12 years, and asks questions about a series of vignettes,
stories, and drawings (Muris et al., 1999). The TOM test measures three subscales of thinking
including precursors to theory of mind, the first manifestations of theory of mind, and more
advanced aspects of theory of mind such as understanding humor (Muris et al., 1999). Muris et
al.’s research suggests that the TOM test is indeed an accurate measure of theory of mind and
thus is appropriate for older children when the standard false belief task may not be (1999).
Other researchers maintain that theory of mind deficits may be related to several poor
functioning cognitive processes found in children with Autistic Disorder, including weak central
coherence and executive dysfunction (Fisher & Happe, 2005; Jarrold et al., 2000; Morgan,
Maybery, & Durkin, 2003; Pellicano, 2007). Central coherence refers to the way an individual
tends to focus on an object or person as a whole rather than focusing on smaller parts of stimuli
(Jarrold et al., 2000). Executive function refers to attributing various qualities to an individual,
such as flexibility and the ability to direct behavior toward the future (Pellicano, 2007).
Essentially, executive function refers to planning, set shifting, coordination, and inhibition
(Fisher et al., 2000; Pellicano, 2007).
Unlike individuals without autism, an individual with autism is believed to have weak
central coherence, suggesting he or she tends to focus primarily on the smaller parts of stimuli
(Jarrold et al., 2000; Morgan et al., 2003). Weak central coherence in children with autism has
been found through a variety of tests, including the Embedded Figures Test, a test requiring
individuals find a specific object or shape within a larger pattern (Jarrold et al., 2000; Morgan et
al., 2003). Although some researchers argue that theory of mind and central coherence are two
unrelated phenomena of Pervasive Developmental Disorders because they are responsible for
entirely different tendencies, Jarrold et al. attempted to find a relationship between the two
(2000). Their experiments showed a weak positive relationship between theory of mind deficits
and weak central coherence (Jarrold et. al., 2000). However, the relationship was less apparent
between typically developing children and those with autism, and more apparent when
comparing the verbal mental ages of their participants (Jarrold et al., 2000). Thus, theory of
mind deficits and weak central coherence were found in both sets of participants, suggesting that
an individual need not have Autistic Disorder to exhibit both theory of mind deficits and weak
central coherence.
Similarly, Pellicano (2007) and Fisher & Happe (2005) have tested for a potential
relationship between theory of mind deficits and executive dysfunction. An individual with
Autistic Disorder often appears to be rigid and inflexible and may be unable to direct behaviors
toward the future, thus showing an executive dysfunction (Pellicano, 2007). The experiments in
this area of research consisted of training programs in both theory of mind and executive
function tasks for children with Autistic Disorder and typically developing children (Fisher &
Happe, 2005; Pellicano, 2007). A relationship was indeed found between theory of mind and
executive function in both studies (Fisher & Happe, 2005; Pellicano, 2007). However, the extent
of the relationship was inconsistent in each of the studies, as the training did not consistently
yield higher scores in executive function performance (Fisher & Happe, 2005; Pellicano, 2007).
Although the results of these studies do not suggest a significant relationship between theory of
mind and executive function, the findings may imply an important advancement in the study of
theory of mind in autism research, as the training programs did improve performance in theory of
mind tasks (Fisher & Happe, 2005; Pellicano, 2007).
Finally, some researchers argue that despite successful research on theory of mind, a
child’s understanding of others’ intentions has been often ignored in the research (Carpenter et
al., 2001). Carpenter et al. argued that as intentions are less difficult to understand than the
thoughts and beliefs of others, autism research would benefit greatly from studying intentions in
greater depth (2001). Carpenter et al. also suggested that interpreting others’ intentions may in
fact lead to higher level understanding of mental states (2001). Consequently, Carpenter et al’s
research with children with autism and developmental delays did not find significant differences
in whether the participants understood intentions (2001). Instead, the results suggest that
children with Autistic Disorder show a lower level of complexity in their understanding of
intentions with the deficits appearing less severe than other theory of mind tasks have previously
suggested (Carpenter et al., 2001).
Conclusions
As the research suggests, theory of mind is imperative to the social growth and
development of children. Without theory of mind, children are unable to interpret the thoughts
and beliefs of others, and consequently are unable to attribute meaning to others’ behavior. The
research shows the importance of early mental state discourse, language and communication
skills, and the benefits of training children with autism to improve their performance in theory of
mind tasks such as the false belief task and the TOM test. Ideally, a greater general
understanding of mental states would result.
Although the current research is valuable, it could be extended even further. Future
research could be directed at developing training programs designed to be used in teaching
environments and facilities such as preschools. Such programs could be used as part of the early
intervention programs that are already in place. As these early intervention programs have
already shown great success, especially in the promotion of adaptive skills for children with
autism, training these children in theory of mind tasks may give researchers an opportunity to
test for generalizability of their findings. Additionally, the recommended training programs may
give these children the opportunity to make significant steps toward better adapting to the social
world in which they live.
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