Autism and Theory of Mind

We often hear or read that those with autism lack “Theory of Mind” (ToM). What exactly does this mean? For the answer we went to our own Dr. Emily Rastall. Here’s what she told us.

Theory of Mind (ToM) is defined as an understanding that others have minds that are different from our own. More specifically, it is the understanding that others have thoughts, feelings and perspectives that differ from ours. In short, ToM allows us to understand and predict the behaviors of others based on what we think they might be thinking. For example, though we may not be feeling sad ourselves, we can imagine another’s perspective and empathize with someone who might be having a hard day.

The classic Theory of Mind task (called the Sally-Anne task) exemplifies this understanding that others have minds that are different from our own. In the task a child must determine what another’s response would be based on false belief. In the task, the child observes two models (Sally and Anne). One of the models (Sally) places an object in a hiding spot and then leaves. The second model (Anne) moves the object to a new hiding spot.

When Sally returns, the child must indicate where she (Sally) will look for the object. In order to respond correctly, the child must be aware that Sally did not see the object being moved and therefore has the false belief that the object is where she originally placed it. Researchers have shown that prior to four years of age, children’s responses are inconsistent, with some children showing this ability while others do not. However, between the ages of 4 and 6 years, this ability emerges and becomes consistent in typically-developing children. This “mentalizing” ability appears to be impaired in individuals with autism.

Within the context of autism spectrum disorder (ASD), deficits in ToM may be at the core of many of the behaviors associated with the disorder. For example, ToM limitations may lead to misreading or failure to read emotions, intentions, or cues from others. In addition, ToM challenges may lead to limited expression of empathy toward others. ToM deficits may also result in one approaching a social situation with assumptions that may not be accurate. Finally, reciprocity (the give-and-take, mutual benefit of a relationship) may be impacted, as a result of having challenges picking up on cues from the social environment.

ToM may help parents and others to understand the often perplexing behavior of children with ASD such as:

• Inappropriate reaction to the emotional expression of others (i.e.: laughing or not “getting it” when someone is angry or sad)
• Difficulty understanding that their behavior has an effect on others
• Assuming that what they think and feel is what others think and feel
• Difficulty with taking turns in a conversation and asking questions about the other person or allowing him or her to share what their interests are
• Difficulty understanding characters in a book or movie or engaging in pretend play

As such, it’s important for family members to remember that these perplexing behaviors are not willful or intentional, but the downstream effect of challenges with TOM.