Understanding the Relationship Between Theory of Mind, Autism and Applied Behavior Analysis

What is Theory of Mind?
Theory of Mind is a term that was defined by Premack and Woodruff (1978) as the ability to assign mental states to oneself and to others. That is, the ability to infer what other people believe given a certain situation, allowing one to predict what they will do.  Since this study on non-humans, the research as to how this theory applies to humans has grown exponentially and we have come to believe that possessing it is critical in the development of social skills.

How Does This Relate to Autism?
We know that autism comes with delays in verbal and social development, but looking closer at the diagnostic criteria outlined in the DSM 5, a few critical features stick out. 

In the area of social communication and interaction, to be diagnosed with autism you must display: deficits in social-emotional reciprocity (eg. engaging in one-sided conversations), deficits in nonverbal communicative behaviors typically used in social interactions (eg. impairments in social eye contact) and deficits in developing and maintaining relationships appropriate to developmental level (eg. difficulty with imaginative play, difficulty recognizing another’s distress or disinterest). These areas of social deficit prompted a group of researchers, Baron-Cohen, Leslie and Firth to ask: Does the child have a “theory of mind?”

The Sally Anne Test
In their study, Baron-Cohen, Leslie and Firth designed a test in which three groups of children – one with down syndrome, one diagnosed with autism and one neuro-typical group – with similar IQs and developmental ages were asked to respond to a scenario that required the use of perspective taking. Called the Sally Anne test, a scenario was presented in which Sally placed a marble into her basket. Then she left the scene, and the marble was transferred by Anne and hidden in her box. Then, when Sally returned, the experimenter asked the critical question: “Where will Sally look for her marble?”

All of the children were able to answer comprehension questions about the scenario (eg. who is Sally? Where is the marble really?). However, when it came to the critical question, the other two groups pointed to the basket (where Sally had left the marble) while 80% of the children with autism pointed to where the marble actually was (the box). The results suggest that the other children were able to appreciate the difference between their own knowledge and the doll’s knowledge, while the children with autism were not.

Theory of Mind and Applied Behavior Analysis
In applied behavior analysis we look at behavior and the environment to explain what we do. Looking at the concept of Theory of Mind, we ask how does this behavior develop? We hypothesize that behaviors involved in perspective taking and those involved in making inferences of other’s private events are developed at an early age make up the sum of skills needed to develop a Theory of Mind. These skills include joint attention, attributing subjective experiences to other people (such as in pretend play) and labeling emotions in others. In terms of making inferences, we believe this may be a higher order of delayed imitation. When an imitation becomes more complex and delayed, a person engaging in delayed imitation will experience the same sensations experienced by the person they observed. For example, seeing a person wrap herself in a blanket to keep warm doesn’t not make the observer privy to the warmth she experiences. However, if they imitate this behavior when they are cold and wrap themselves in a blanket, they will then feel of the warmth that the other person was experiencing. The next time they see this person, they will be able to infer that she is wrapped in a blanket because she is cold. In this way, we believe that imitation in general may play a key role in the development of perspective taking. Similarly, when we teach our children to say “ouch” when something hurts, we are not subject to the pain they are feeling. By assigning that label, we are teaching them to verbalize a sensation that can only be experienced by themselves. Perspective taking would then occur if when we said “ouch” the child would ask “Mommy hurt?” As children continue to experience and label their own private events, they are also learning to label the private events of others when they are seen in similar situations. It follows, then, that language (whether verbal, sign or augmentative) plays a critical role in perspective taking.

How Can We Use This Information?
As we continue to grow in our understanding of the mechanisms behind our own social behavior, there are some important takeaways from the research on the Theory of Mind and how it relates to the difficulties experienced by those with autism. First, it requires joint attention – the ability to follow another’s gaze and attend to the same stimuli. Second, it requires verbal communication to confirm and reinforce that the right stimuli is being attended to. Third, it requires a well-developed imitative repertoire. Lastly, it requires practice. Young children are constantly trained in perspective training when in the classroom, at the playground or even at home with their siblings. We ask, “How would you feel if someone grabbed your favorite toy from you?” And then we teach them how to attribute that same feeling to the offended party. Because children with autism do not engage in typical play, and thus do not often encounter these types of situations, they do not get a chance to practice these skills. However, we can create scenarios in which to practice perspective taking everyday. From talking about objects in the distance (joint attention) to labeling our own private events and modeling behaviors that alleviate them (I’m hungry so I’m going to get some food from the fridge), we can create experiences that can promote growth in this area and can ultimately lead to deeper connections with time and practice.

By Francoise Nelson, M.S., RBT
Behavior Technician at Verbal Beginnings, LLC

Baron-Cohen, S., Leslie, A., Frith, U. (1985). Does the Autistic Child Have A “Theory of Mind?” Cognition, 21 (1), 37 – 46.
Spradlin, J. and Brady, N (2008). A Behavior Analytic Interpretation of Theory of Mind. International Journal of Psychology and Psychological Therapy (Rev Int Psicol Ter Psicol), 8(3), 335-350.

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