Controversy #4: Theory of the Mind

As I've been researching and ingesting information about autism, there is only one listed autism "characteristic" that really frustrates me. I am okay with stimming, with speech delay, with echolalia, with sensory processing issues, with developmental delays. I know that's part of the deal and it is what it is. However, when I read about the Theory of the Mind, I get upset mostly because I think that the premise on which it is based is faulty and misleading.

What is Theory of the Mind (ToM)?

Theory of Mind can be summed up as a person’s inability to understand and identify the thoughts, feelings and intentions of others. Individuals with Asperger Syndrome/HFA can encounter have difficulty recognizing and processing the feelings of others, which is sometimes referred to as “mind-blindness”. As a result of this mind-blindness, people with AS may not realize if another person’s behaviors are intentional or unintentional.

From  Executive Functioning and Theory of Mind, Autism Speaks

ToM in autistic children was based on the Sally-Anne test, which was a 1985 test which was set up as follows: Sally has a marble. She puts it in her basket. Sally leaves. The child then witnesses Anne come and take Sally's marble out of her basket and put it in her own box. Children are then asked the Belief Question "Where will Sally look for her marble?" Per the Wikipedia link above, "23 of the 27 clinically unimpaired children (85%) and 12 of the 14 Down's syndrome children (86%) answered the Belief Question correctly. However, only four of the 20 autistic children (20%) answered correctly. (emphasis mine) Overall, children under the age of four, along with most autistic children (of older ages), answered the Belief Question with "Anne's box", seemingly unaware that Sally does not know her marble has been moved."

A few things about this study: (1) it was done in 1985. There have been like 18 DSM's in the 30 intervening years (not really -- we're on DSM-V and they were on DSM-III in 1985). The point is, ASD is diagnosed differently now with a significantly wider umbrella, so the population that they chose were different than today's would be. (2) One of the hallmarks of ASD is language processing disorders. So it follows that no one should be surprised when an autistic child has problems understanding the question that is being asked or how to answer it. (3) Autistic people tend to be concrete thinkers, which when coupled with a language processing disorder can lead to not understanding the question being asked because they know that the marble is in Anne's box. (4) They are basing this theory on how an autistic child's brain works, not an adult's. (5)  To extrapolate their failure to answer this one question "correctly" to them being unable to identify the "thoughts, feelings, and intentions of others" is a stretch in my view.

So, there are a few ways to think about this. One, we can take it at face value and say that autistic people can't understand that other people have thoughts and feelings and ostracize them even further. Or we can say that autistic people have a more difficult time understanding other people; it takes them longer to interpret thoughts and feelings and may need to be taught how.

I see it more as a developmental delay. I'm interested to know if an autistic adult would answer the Belief Question correctly. All children need to be taught empathy: how many times do you tell your NT child to "be gentle" when petting a dog or a cat? Don't you take your child when they hurt another child and explain to them what they did and how that made the other person feel? Their language deficits and the fact that they are concrete thinkers can create a barrier to ASD people expressing empathy but that does not mean that they are incapable of it. I also see a need to help autistic people to understand motivating behaviors. Since they have difficulty in reading a person and their behaviors, it makes them easy targets for bullies and scammers.

In my last post, I specifically debunked this idea that Elias, because he is autistic, does not intuit or understand other's feelings. The reason that he reacted the way he did to me talking about autism is because he saw me upset about it months ago after he was first diagnosed. He specifically correlated talking about autism with anxiety and sadness. Of course I feel massively guilty about this, so I'm in damage-control mode right now. The point is that he gets it. He may not understand every emotion, but he is not unaware of, nor indifferent to, them.