Theory of Mind development in both autistic and typically-developing children

(A Critical Discussion)

Introduction

The development of Theory of the Mind (ToM) during the first five years of life is a fundamental process in typical childhood development. The term Theory of Mind describes the ability to understand people as mental beings and having mental states that do not necessarily coincide with ours (Astington and Edward, 2010).

Although research on ToM is profuse, there are still many areas where research has been unable to find satisfactory answers and many findings where the interpretation is not consensual. Such is the case of the development of ToM is children with Autism Spectrum Disorder (ASD). Children in ASD show evidence of having an impaired ToM, but a body of research is now challenging this mainstream view (e.g. Chevallier, Parish-Morris, Tonge, Miller and Schultz, 2014), either proposing alternative interpretations, questioning the methodology used in tasks designed to evaluate the existence of ToM, or expanding the theory to encompass additional features of ASD.

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The current paper discusses the development of ToM in typically developing (TD) children and how it compares to its development in children with ASD. It starts by describing how ToM develops in TD children, highlighting some of the critical elements influencing development. It then continues to describe how ToM develops in Children with ASD in comparison to TD children, expanding on the criticisms that challenge the mainstream view. Finally, it proposes that new technological developments in the area of e-Learning be used, in the first place, to help address some of the challenges with studying ASD and, in a second stage, as a tool to support the gradual development of ToM in children with ASD.

 

Development of Theory of Mind in Typical Developing Children

Arguably, the most important development during the first five years of life is the development of a Theory of Mind. ToM describes the fact that children get to a point in their maturation where they are able to separate reality from what goes on in their mind, as well as separate what goes on in their mind from what might be going on in other people’s minds. This crucial early development is the foundation for healthy and meaningful interactions with others throughout life.

Researchers have developed several tasks and tests to assess the presence of ToM in children, many of which evaluate children’s ability to identify other’s false beliefs (Mitchel, 2010). Wiemmer and Perner’s (1983) Maxi and his chocolate bar is a good example: Maxi puts his chocolate bar in a cupboard, but without Maxi realising, his mom moves it to the fridge. The question put forward to participating children is: where will Maxi look for the chocolate bar? Wimmer et al (1983) study has shown that children with 4 years old (but not younger) are able to correctly identify that Max would still believe the chocolate bar is in the cupboard.  This has been a ground-breaking experiment with its results challenging the Piagetian view that children under 7 years old are egocentric and unable of understanding other’s mental states (Mitchel, 2010).

Research has further shown that children under the age of 4 have also difficulties in accessing their own states of mind, i.e., they seem to be unable to reflect on how they feel and on what they are thinking (Gopnik and Astington, 1988). This lack of metacognition could explain why children are unable to understand other people’s minds: they simply do not know their own mind and, therefore, have no basis for understanding other people’s minds (Mitchel, 2010).

Another pertinent question should then follow: is ToM a sudden step-like development or, on the contrary, is it part of a slower gradual development that emerges at around 4 years of age? Several studies have cast some doubts on the idea that ToM is a step-like development. For instance Lewis and Osborne (1990) modified the question in Maxi and the chocolate bar task to “Where will Maxi look for the chocolate bar first of all?”, resulting in children having a better chance at answering correctly. The researchers claimed that earlier experiments yield more incorrect answers because children did not understand the question being posed. Moreover, Mitchell and Lacohee (1991) suggest that children under 4 years do indeed understand the concept of belief, but are unable to use it without an explicit anchor to reality. And Leslie (1987, cited in Baron-Cohen, 2009) reported 24 months old children being able to read what is on the other person’s mind while engaged in pretend play.

Furthermore, research has also been able to link social factors to the rate at which ToM develops in TD children. Meins, Fernyhough , Russell and Clark-Carter (1998), for instance, have shown that securely attached children performed better on false-belief tasks at 49 months of age. Ruffman, Slade and Crowe (2002) have shown that Mothers’ use of mental state language is correlated with children’s later performance on tasks that evaluate children’s understanding of desires, emotions and beliefs. Welch-Ross (1997) showed children’s scores in ToM tasks were related to their involvement in memory conversations with their mothers. And Jenkins and Astington (1996) have presented evidence suggesting that 3 years old children with older siblings have a higher chance of passing a test of false belief than those with the same age, but having no siblings. It seems clear that the existing body of research points out in the direction of a gradual development of a ToM.

It follows directly from the impact that social factors have on the development of ToM, that the intrinsic characteristics of the child are likely to also dictate when ToM becomes manifest (Mitchell, 2010). For instance, a mother will have the chance to have more or less conversations about the past depending on the child’s character. And one extreme case where the child’s characteristics are likely to limit the impact of social factors can be found in children with Autism Spectrum Disorder.

 

Mind-blindness: the Impaired Theory of Mind in Children with Autism Spectrum Disorder

Autism Spectrum Disorder is characterised by a triad of impairments in: social interaction; communication, and unusual repetitive behaviours and narrow interests (Wing and Gould, 1979). While it is required for all three impairments to be present (Diagnostic and Statistical Manual of Mental Disorder, fourth edition, revised [DSM-IV-TR]; American Psychiatric Association, 2000), the degree to which each of these elements affects the person with ASD fluctuates from one individual to the next. Moreover, 50% of children with ASD have an IQ below 50, with the other 50% having learning difficulties (Lewis, 2010).

Over the past years, several theories have been put forward to explain the core autism deficits, but no single theory has been able to successfully account for all elements (Lewis, 2010). Nevertheless, some of these theories have gone a long way in explaining the core deficits. Baron-Cohen, Leslie and Frith (1985) used the Wimmer and Prener’s puppet play task to show that 80% of children with autism have difficulties in understanding that people might hold beliefs that are different from their own. This and a series of subsequent related studies have conducted to the development of the Mind-blindness theory, that posits that an impaired mind-reading is the overarching deficit in autism (Lewis, 2010).

The Mind-blindness theory suggests that children with ASD have a delay in the development of their Theory of Mind, resulting in a confused and frightened view of people’s behaviours (Baron-Cohen, 2009), in turn, leading to the apparent social withdrawal and aloofness that characterises them. Baron-Cohen (2009) reported that ASD toddlers show less frequency of joint attention (e.g. following another person’s gaze) compared to 14 months-old TD children. Children with ASD also use less pretend play  compared to their TD counterparts (Baron-Cohen, 2009). Baron-Cohen and Goodhart (1994) have also shown that by the age of 3 children understand that seeing leads to knowing while children with ASD only evidence this at a later stage.

ToM appears to provide a solid base for explaining the first two elements of the triad of impairments: it seems reasonable to assume that the mindreading difficulties exhibited by children with ASD will be at the root of their social interaction and communication deficits (Lewis, 2010). Moreover, neuroimaging studies identified areas like the medial prefrontal cortex, temporal cortex including the temporal poles and the tempoparietal junction, amygdala anterior cingulate and insula (Korkmaz, 2011; Baron-Cohen, 2009) as being activated in ToM related tasks; areas known as integrating the “social brain” (Baron-Cohen 2009).

 

Shortcomings, Criticisms and Evolutions to the Mind-blindness ToM

Impairment inToM as a chief element behind the social and communication deficits exhibited by children in ASD is, nevertheless, less and less consensual (Chevallier et al, 2014). Chevallier et al (2014) suggest that the experimenters might act as a confound in studies comparing ToM in typically developing (TD) children and in children with ASD. According to these researchers, the very nature of ASD, characterised by a reduced social motivation, would make children with ASD less susceptible to the audience effect and thus also indifferent to how their performance is seen by others. The audience effect is a demonstrated social phenomenon that argues that, in the presence of others, individuals will try to augment their reputation, potentially trying harder to achieve the intended outcomes. Chevalier et al (2014) asked a group of TD children and a group of children with ASD to execute a ToM task under two conditions: administered by a human experimenter or administered by a computer. These researchers found that ToM deficits are only apparent when the task is administered by a human and that only TD children benefit from the presence of the human experimenter.

In a study by Peterson et al. (2013, cited in Chevalier, 2014) children with ASD that failed a specific ToM task, had their performance increased when they participated in a task involving a reward, lending support to the idea that 1) these children are not socially motivated by the presence of others and 2) their ability to perform is not as impaired as it could be initially predicted.

Moreover, ToM is unable to account for the repetitive behaviours and narrow interests that compose the third element in Wing’s triad (Lewis, 2010). This has been accounted for by adding the Weak Central Coherence theory (Frith and Happe, 1994). According to the Weak Central Coherence theory, children with ASD show an inability to integrate disperse information to produce the high level picture. It is this weakness in central coherence that makes them hostage of details and repetitive movements (Lewis, 2010).

To circumvent the noticeable shortcomings of the Mind-blindess theory of mind, Baron-Cohen (2009) proposed the Empathizing-Systematizing theory (E-Z). Baron-Cohen argues that ToM is focused on the impaired cognitive component of empathy, not focusing on the average to above average systematizing component. According to the researcher, the systematizing component describes the motivation children with ASD have to analyse and construct systems. Systematizing is seen in the E-Z theory as a strength that can explain several of the non-social features found in Autism (Baron-Cohen, 2009).

 

Conclusion

As discussed, the development of Theory of Mind is the central element of human development during the first five years of life. The ability to reflect on own thoughts and recognise others’ different state of mind is a vital competence allowing individuals to establish meaningful, empathic relations and to function as social beings.  Conversely, the inability to develop ToM can have devastating consequences. Research has proposed that an impaired ToM explains many of the deficits characteristic of Autistic Spectrum Disorder, in particular those related with social and communication skills. Children with ASD might lack the understanding of other individuals’ state of mind, in turn resulting in a confusing view of the world and lack of motivation to interact with it.

Arguably, the recent technological developments in the area of e-Learning (e.g. scenario based learning using computer animated characters and touchscreen solutions) could be used, in the first place, to help address some of the challenges with studying ASD and, in a second stage, as tools to support the gradual development of ToM in children with ASD. In particular, these technologies could initially buffer human interventions during experiments, facilitate the implementation meaningful incentives to achieving objectives, and act as tools to lead the ASD child to move from a detail view to a slightly more general view. The use of these technologies should, therefore, be the subject of further research.

 

References

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