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Theory of mind Aspect Behaviour Support
Contents Introduction Different levels of Theory of Mind & measurement The developmental context Language and Theory of Mind T.O.M, Executive Function & Central Coherence Teaching theory of mind & effectiveness
What is Theory of Mind? The ability to ‘put your self in others shoes’ or Mindreading “Who is he?” “I’m leaving you!”…
Three groups key to understanding Theory of Mind Limited T.O.M = Mindblindness  ‘ Theory of mind’ was coined as a term by Premack & Woodruff, primatologists who were discussing a chimpanzee
Why is it important? Allows us to predict and explain other people’s behaviour and emotions Allows us to be compassionate, to keep a secret or to tell a lie, to pretend to be someone else in play, to be sarcastic, to show and share & to understand accidental behaviour Allows us to understand inference in communication e.g. “it’s cold in here” (point to window left open) Many researchers have argued that lack of TOM is the fundamental impairment at the root of autism  and can  explain the social and communication deficits (see Learning Portal)
Different  levels  of Theory of Mind & measurement First order Second order Third and higher order Smarties & Sally Anne test Ice Cream Van Story 12 Strange Stories
First Order
The Smarties test A child is shown a Smarties tube, and asked what they think is inside. Naturally, they nearly always say "Smarties". Then they are shown that the tube actually contains pencils. Then they are asked what they think a friend will say when they are brought in and shown the tube, and asked what is inside.  "When I first showed you this tube, what did you think was in it?", they will often answer "pencils". Smartie  test  video
Sally Anne Test This is Sally. Sally has a basket. This is Anne. Anne has a box. Sally has a marble. She puts the marble into her basket. Sally goes out for a walk. Anne takes the marble out of the basket, and puts it into the box. Now Sally comes back. She wants to play with her marble. Where will Sally look for her marble? Sally Anne Video
 
Second Order
Second Order This is Mary and John, they are school friends in the park. Here comes the ice cream van. John wants to buy an ice cream but he left his money at home. Ice cream man says ‘don’t worry, I’ll be in the park all day, you’ve got time to go home’.  John runs home to get his money. The ice cream man changes his mind & tells Mary ‘I can’t stay here, I’m off to the church’. Mary goes home and the ice cream man sets off to the church. But on the way the ice cream man meets John & says ‘I’m off to the church now instead’.  In the afternoon, Mary goes to John’s house & knocks on the door. John’s mum answers the door & says ‘oh, John has gone out to buy an ice cream’… (Perner & Wimmer)  Q =  Where does Mary think John has gone to buy an ice cream?  C  = ‘The park’
Third order & higher functions Strange  stories Faux pas  test Autism and the effect on social understanding
12 Strange stories Lie (Dentist):  John hates going to the dentist because every time he goes to the dentist he needs a filling, and that hurts a lot. But John knows that when he has toothache, his mother always takes him to the dentist. Now John has bad toothache at the moment, but when his mother notices he is looking ill and asks him ‘‘Do you have toothache, John?’’. John says ‘‘No, Mummy’’. 1. Is it true what John says to his mother? 2. Why does John say this? Assessment of Theory of mind 2009.pdf
12 Strange stories Misunderstanding (Glove):  A burglar who has just robbed a shop is making his getaway. As he is running home, a policeman on his beat sees him drop his glove. He doesn’t know the man is a burglar, he just wants to tell him he dropped his glove. But when the policeman shouts out to the burglar, ‘‘Hey you, Stop!’’, the burglar turns round, sees the policeman and gives himself up. He puts his hands up and admits that he did the break-in at the local shop. 1. Was the policeman surprised by what the burglar did? 2. Why did the burglar do this, when the policeman just wanted to give him back his glove?
Faux Pas test Sally is a three-year-old girl with a round face and short blonde hair. She was at her Aunt Carol's house.  The doorbell rang and her Aunt Carol answered it. It was Mary, a neighbour. "Hi,“ Aunt Carol said, "Nice of you to stop by."  Mary said, "Hello," then looked at Sally and said, "Oh, I don't think I've met this little boy. What's your name?" Faux_Pas_Recog_Test.pdf Did anyone say something they shouldn't have said or something awkward?
TOM & Language Children’s level of T.O.M will affect their ability to use:  Perceptual words such as see or look Words for physiological states such as hungry, tired.  Emotional words such as scared or happy.  Desire terms such as want Mind related words ‘know’ ‘believe’ and ‘think’
Important developmental milestones 1. Birth to 18 months 2. Understanding the eyes 3. Understanding desires & emotions 4. Understanding beliefs & false beliefs 5. Deception and empathy
1. Birth to 18 months Children live in present & know only what they see (peek-a-boo) Object permanence  - if an object is hidden it ‘ceases to exist’  Once developed infants can understand that things exist even if they can’t be seen
Self awareness & the mirror test
2. Understanding the eyes  The Facts of vision   You see with your eyes Understanding direct line of sight vs eyes averted Understanding the directionality of gaze Others see from a different perspective  “ look at this” on the phone
Eye contact Autism and eye contact Whites of the eye
Link between seeing & knowing Understanding that attention = a psychological spotlight Joint attention – two people understanding what each other is looking at Autism Diagnostic Observation Scale (ADOS) Joint Attention
3. Understanding desires & emotions Emotional expressions are universally understood and conveyed Basic emotions = Happy sad angry disgust fear surprise  Understanding surprise involves knowing what people were expecting or what was in their mind…
Visual cliff experiment Babies are reluctant to crawl on a glass surface. If the drop is a little smaller, so that the situation is ambiguous, the babies use social referencing to judge whether or not to cross. The carer is sat opposite them, and asked to adopt either a happy or fearful expression. Sure enough, the baby will cross when the carer is happy but will not when the carer is fearful.
ASD & Emotions One of the most striking characteristics of people diagnosed with autism is their impaired ability to socially interact with others, which affects almost every aspect of their daily lives (Howlin, 1998; Zager, 1999).  Those with a diagnosis of HFA or AS can have difficulty in naming the facial expression of others (Grossman et al., 2000) and defining emotions, particularly complex emotions such as pride or embarrassment (Capps et al., 1992).  A child diagnosed with HFA or AS may also describe events in terms of actions, not feelings, and may display their own emotions in a way that is seen as socially unacceptable, for example, hugging a total stranger.  Studies have found that that those with a diagnosis of autism are more flat/neutral in their expressions of emotion (Yirmiya et al., 1989) and express less positive emotion (David & Tager-Flusberg, 1997).  When comparing those diagnosed with Autism with those diagnosed with Down’s Syndrome, Loveland et al. (1994) found the participants diagnosed with Autism produced fewer recognizable facial expressions than participants with Down’s Syndrome. 
4. Understanding beliefs & false beliefs “ Ellie the Elephant loves to drink milk, but hates cola. Mickey the Monkey puts some cola in a milk carton and offers it to Ellie to drink. Will Ellie feel happy or sad when she tastes the drink?” By age 4 understand how feel when drink By 6 understand how felt before tasting the drink
Play and pretence Pretend play  Using one object as another Attributes properties to an object that it does not have Refers to an absent object as if they are present 18 months start to treat dolls as people 2½ years act out scenarios 3-4 discuss thought processes
5. Deception and empathy Empathy = The ability to put your self in others shoes, understanding how they feel and what the world looks like from their perspective.  Sympathy = how we feel when we are moved by another person Deception & ASD video
Deception & Lies Deception  involves the deliberate intention to alter another’s beliefs Children start to tell lies at 3 but aren’t very good at it  ‘I didn’t break the lamp but wont do it again’  Deception evolves at about 5 years old  Lying   (i) simple denial or defensive behaviour with intent to avoid punishment (a learned phrase ) not deliberate deceit.  Can you help tidy up please ‘I’m tired’ Can you help get ready for school ‘I’m tired’ OK time for bed ‘I’m tired’ (ii) Misleading others by creating false beliefs
TOM & Executive Function & Central Coherence
Teaching and learning TOM Match learning  to developmental stages Understanding eye gaze Understanding emotions Understanding beliefs Understanding beliefs & false beliefs Understanding deception and empathy Generally: People with ASD can rote learn strategies to work things out but often this will not come naturally
Understanding eye gaze Hide and seek Can you see me Who is x looking at computer game?
Understanding emotions Aspect website  Transporters Baron Cohen DVD Dotolearn.com
Understanding beliefs & false beliefs Social stories Comic Strip conversations Social autopsies Wellman H.M. et al. (2002).  Thought-bubbles help children with autism acquire  an alternative to a theory of mind.  Autism. 6(4), pp. 343-363.  Many parents explain others thinking in disagreements ‘he thought you had finished’ ‘how would you feel if he did that to you?’ better than reprimand or punishment
Does it work? Research Autism Website  Theory of Mind training programmes are designed to teach individuals with autism how to recognise mental states (thoughts, beliefs, desires, intentions, and emotions) in oneself or others, and to be able to make sense of and predict actions. There are a variety of programmes designed to teach theory of mind. For example, some programmes are based on teaching children to visualise other people’s thoughts and emotions by imagining those thoughts and emotions as pictures or thought bubbles.  We are currently reviewing the literature on the use of Theory of Mind training for people with autism. So far we have identified 11 studies published in peer-reviewed journals on this issue. Ranking :         
Quiz – how does TOM help? Allows us to understand others emotions to predict and explain other people’s behaviour  to be compassionate to keep a secret  to tell a lie to pretend to be someone else in play to be sarcastic or understand sarcasm to show and share  to understand accidental behaviour to trick others to understand inference in communication
Further information ◄   Books  Websites  ►   www.autism-pdd.net   www.researchautism.net   www.whizkidgames.com   Articles  ▼ O’Hare et al. (2009) A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds. J Autism Dev Disord 39:916–928 Baron-Cohen, S., O’Riordan, M., Jones, R., Stone, V.E. & Plaisted, K. (1999). A new test of social sensitivity: Detection of faux pas in normal children and children with Asperger syndrome.  Journal of Autism and Developmental Disorders , 29, 407-418.

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Theory Of Mind

  • 1. Theory of mind Aspect Behaviour Support
  • 2. Contents Introduction Different levels of Theory of Mind & measurement The developmental context Language and Theory of Mind T.O.M, Executive Function & Central Coherence Teaching theory of mind & effectiveness
  • 3. What is Theory of Mind? The ability to ‘put your self in others shoes’ or Mindreading “Who is he?” “I’m leaving you!”…
  • 4. Three groups key to understanding Theory of Mind Limited T.O.M = Mindblindness ‘ Theory of mind’ was coined as a term by Premack & Woodruff, primatologists who were discussing a chimpanzee
  • 5. Why is it important? Allows us to predict and explain other people’s behaviour and emotions Allows us to be compassionate, to keep a secret or to tell a lie, to pretend to be someone else in play, to be sarcastic, to show and share & to understand accidental behaviour Allows us to understand inference in communication e.g. “it’s cold in here” (point to window left open) Many researchers have argued that lack of TOM is the fundamental impairment at the root of autism and can explain the social and communication deficits (see Learning Portal)
  • 6. Different levels of Theory of Mind & measurement First order Second order Third and higher order Smarties & Sally Anne test Ice Cream Van Story 12 Strange Stories
  • 8. The Smarties test A child is shown a Smarties tube, and asked what they think is inside. Naturally, they nearly always say "Smarties". Then they are shown that the tube actually contains pencils. Then they are asked what they think a friend will say when they are brought in and shown the tube, and asked what is inside. "When I first showed you this tube, what did you think was in it?", they will often answer "pencils". Smartie test video
  • 9. Sally Anne Test This is Sally. Sally has a basket. This is Anne. Anne has a box. Sally has a marble. She puts the marble into her basket. Sally goes out for a walk. Anne takes the marble out of the basket, and puts it into the box. Now Sally comes back. She wants to play with her marble. Where will Sally look for her marble? Sally Anne Video
  • 10.  
  • 12. Second Order This is Mary and John, they are school friends in the park. Here comes the ice cream van. John wants to buy an ice cream but he left his money at home. Ice cream man says ‘don’t worry, I’ll be in the park all day, you’ve got time to go home’. John runs home to get his money. The ice cream man changes his mind & tells Mary ‘I can’t stay here, I’m off to the church’. Mary goes home and the ice cream man sets off to the church. But on the way the ice cream man meets John & says ‘I’m off to the church now instead’. In the afternoon, Mary goes to John’s house & knocks on the door. John’s mum answers the door & says ‘oh, John has gone out to buy an ice cream’… (Perner & Wimmer) Q = Where does Mary think John has gone to buy an ice cream? C = ‘The park’
  • 13. Third order & higher functions Strange stories Faux pas test Autism and the effect on social understanding
  • 14. 12 Strange stories Lie (Dentist): John hates going to the dentist because every time he goes to the dentist he needs a filling, and that hurts a lot. But John knows that when he has toothache, his mother always takes him to the dentist. Now John has bad toothache at the moment, but when his mother notices he is looking ill and asks him ‘‘Do you have toothache, John?’’. John says ‘‘No, Mummy’’. 1. Is it true what John says to his mother? 2. Why does John say this? Assessment of Theory of mind 2009.pdf
  • 15. 12 Strange stories Misunderstanding (Glove): A burglar who has just robbed a shop is making his getaway. As he is running home, a policeman on his beat sees him drop his glove. He doesn’t know the man is a burglar, he just wants to tell him he dropped his glove. But when the policeman shouts out to the burglar, ‘‘Hey you, Stop!’’, the burglar turns round, sees the policeman and gives himself up. He puts his hands up and admits that he did the break-in at the local shop. 1. Was the policeman surprised by what the burglar did? 2. Why did the burglar do this, when the policeman just wanted to give him back his glove?
  • 16. Faux Pas test Sally is a three-year-old girl with a round face and short blonde hair. She was at her Aunt Carol's house. The doorbell rang and her Aunt Carol answered it. It was Mary, a neighbour. "Hi,“ Aunt Carol said, "Nice of you to stop by." Mary said, "Hello," then looked at Sally and said, "Oh, I don't think I've met this little boy. What's your name?" Faux_Pas_Recog_Test.pdf Did anyone say something they shouldn't have said or something awkward?
  • 17. TOM & Language Children’s level of T.O.M will affect their ability to use: Perceptual words such as see or look Words for physiological states such as hungry, tired. Emotional words such as scared or happy. Desire terms such as want Mind related words ‘know’ ‘believe’ and ‘think’
  • 18. Important developmental milestones 1. Birth to 18 months 2. Understanding the eyes 3. Understanding desires & emotions 4. Understanding beliefs & false beliefs 5. Deception and empathy
  • 19. 1. Birth to 18 months Children live in present & know only what they see (peek-a-boo) Object permanence - if an object is hidden it ‘ceases to exist’ Once developed infants can understand that things exist even if they can’t be seen
  • 20. Self awareness & the mirror test
  • 21. 2. Understanding the eyes The Facts of vision You see with your eyes Understanding direct line of sight vs eyes averted Understanding the directionality of gaze Others see from a different perspective “ look at this” on the phone
  • 22. Eye contact Autism and eye contact Whites of the eye
  • 23. Link between seeing & knowing Understanding that attention = a psychological spotlight Joint attention – two people understanding what each other is looking at Autism Diagnostic Observation Scale (ADOS) Joint Attention
  • 24. 3. Understanding desires & emotions Emotional expressions are universally understood and conveyed Basic emotions = Happy sad angry disgust fear surprise Understanding surprise involves knowing what people were expecting or what was in their mind…
  • 25. Visual cliff experiment Babies are reluctant to crawl on a glass surface. If the drop is a little smaller, so that the situation is ambiguous, the babies use social referencing to judge whether or not to cross. The carer is sat opposite them, and asked to adopt either a happy or fearful expression. Sure enough, the baby will cross when the carer is happy but will not when the carer is fearful.
  • 26. ASD & Emotions One of the most striking characteristics of people diagnosed with autism is their impaired ability to socially interact with others, which affects almost every aspect of their daily lives (Howlin, 1998; Zager, 1999).  Those with a diagnosis of HFA or AS can have difficulty in naming the facial expression of others (Grossman et al., 2000) and defining emotions, particularly complex emotions such as pride or embarrassment (Capps et al., 1992).  A child diagnosed with HFA or AS may also describe events in terms of actions, not feelings, and may display their own emotions in a way that is seen as socially unacceptable, for example, hugging a total stranger.  Studies have found that that those with a diagnosis of autism are more flat/neutral in their expressions of emotion (Yirmiya et al., 1989) and express less positive emotion (David & Tager-Flusberg, 1997).  When comparing those diagnosed with Autism with those diagnosed with Down’s Syndrome, Loveland et al. (1994) found the participants diagnosed with Autism produced fewer recognizable facial expressions than participants with Down’s Syndrome. 
  • 27. 4. Understanding beliefs & false beliefs “ Ellie the Elephant loves to drink milk, but hates cola. Mickey the Monkey puts some cola in a milk carton and offers it to Ellie to drink. Will Ellie feel happy or sad when she tastes the drink?” By age 4 understand how feel when drink By 6 understand how felt before tasting the drink
  • 28. Play and pretence Pretend play Using one object as another Attributes properties to an object that it does not have Refers to an absent object as if they are present 18 months start to treat dolls as people 2½ years act out scenarios 3-4 discuss thought processes
  • 29. 5. Deception and empathy Empathy = The ability to put your self in others shoes, understanding how they feel and what the world looks like from their perspective. Sympathy = how we feel when we are moved by another person Deception & ASD video
  • 30. Deception & Lies Deception involves the deliberate intention to alter another’s beliefs Children start to tell lies at 3 but aren’t very good at it ‘I didn’t break the lamp but wont do it again’ Deception evolves at about 5 years old Lying (i) simple denial or defensive behaviour with intent to avoid punishment (a learned phrase ) not deliberate deceit. Can you help tidy up please ‘I’m tired’ Can you help get ready for school ‘I’m tired’ OK time for bed ‘I’m tired’ (ii) Misleading others by creating false beliefs
  • 31. TOM & Executive Function & Central Coherence
  • 32. Teaching and learning TOM Match learning to developmental stages Understanding eye gaze Understanding emotions Understanding beliefs Understanding beliefs & false beliefs Understanding deception and empathy Generally: People with ASD can rote learn strategies to work things out but often this will not come naturally
  • 33. Understanding eye gaze Hide and seek Can you see me Who is x looking at computer game?
  • 34. Understanding emotions Aspect website Transporters Baron Cohen DVD Dotolearn.com
  • 35. Understanding beliefs & false beliefs Social stories Comic Strip conversations Social autopsies Wellman H.M. et al. (2002). Thought-bubbles help children with autism acquire an alternative to a theory of mind. Autism. 6(4), pp. 343-363. Many parents explain others thinking in disagreements ‘he thought you had finished’ ‘how would you feel if he did that to you?’ better than reprimand or punishment
  • 36. Does it work? Research Autism Website Theory of Mind training programmes are designed to teach individuals with autism how to recognise mental states (thoughts, beliefs, desires, intentions, and emotions) in oneself or others, and to be able to make sense of and predict actions. There are a variety of programmes designed to teach theory of mind. For example, some programmes are based on teaching children to visualise other people’s thoughts and emotions by imagining those thoughts and emotions as pictures or thought bubbles. We are currently reviewing the literature on the use of Theory of Mind training for people with autism. So far we have identified 11 studies published in peer-reviewed journals on this issue. Ranking :     
  • 37. Quiz – how does TOM help? Allows us to understand others emotions to predict and explain other people’s behaviour to be compassionate to keep a secret to tell a lie to pretend to be someone else in play to be sarcastic or understand sarcasm to show and share to understand accidental behaviour to trick others to understand inference in communication
  • 38. Further information ◄ Books Websites ► www.autism-pdd.net www.researchautism.net www.whizkidgames.com Articles ▼ O’Hare et al. (2009) A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds. J Autism Dev Disord 39:916–928 Baron-Cohen, S., O’Riordan, M., Jones, R., Stone, V.E. & Plaisted, K. (1999). A new test of social sensitivity: Detection of faux pas in normal children and children with Asperger syndrome. Journal of Autism and Developmental Disorders , 29, 407-418.

Editor's Notes

  • #4: Without guess work of understanding what others are thinking this makes no sense Look me in the eye chapter
  • #10: Variations of the test aim to reduce performance factors (ability to follow story and remember) and maintain measurement of competence. None of any of the variations of the test improved performance significantly e.g. use of a Polaroid camera Take a photo of Ernie on the mat relaxing. While it develops here comes Big Bird. When the photo develops, who is in the photo?
  • #22: Sixth Sense lesson example
  • #23: Dawson and Osterling (1994) studied videotapes of first birthday parties of typical children and children who later received a diagnosis of Autistic Disorder and found that the best predictor of future diagnosis was lack of attention to the face of others.
  • #24: two people, one standing beside and one with cupboard door open looking inside – which one knows what is in the cupboard?
  • #25: Story about a girl who’s teddy is stolen when she isn’t looking – ASD identified girl as yawning or tired
  • #28: Harris showed that children were able to respond correctly to these kind of stories by around four years of age, regardless of their own preferences for milk or cola. In other words, they understood that the emotional state of a character depends on their desires. By six, they could also understand how Ellie would feel before actually tasting the drink, showing that they understood the importance of beliefs as well as desires. In the example here, Ellie would be happy at first because she believed that the carton contained milk.
  • #31: Deception involves intention to deceive – Deception can seem sophisticated as we interpret things in a mentalistic way (manipulative) – children or ASD do not have access to others mental states to deceive.
  • #32: TOM located in frontal lobe? People with lesions or tumours lose social judgement
  • #35: http://www.autism-pdd.net/testdump/test17136.htm