THEORY OF MIND – “EMPATHY”
ToM is the ability to recognize and understand thoughts, beliefs, desires, and intentions of other people to make sense of their behaviour and predict what they are going to do next – ie “mind-reading” or “putting oneself in another person’s shoes” or empathy. People with AS do not recognize or understand the cues that indicate the thoughts or feelings of the other person at a level expected for someone of that age.
Examination of ToM skills includes “Strange Stories” for children and “Stories from Everyday Life” for adolescents. Evaluation entails whether the correct reply is achieved by intellectual analysis, rote learning, and memory rather than being immediate and intuitive.
Typical children are remarkably astute at perceiving and understanding social cues as though their mind prioritizes them above other information. This ability dominates the perception of typical people to such a degree that they project human social behaviour on animals and even objects. AS People perceive the physical world more than the social world. The prefrontal cortex, the superior temporal sulcus, and temporal lobes, the areas of the brain that mediate mental states, are activated less in AS people.
Impaired ToM also affects self-consciousness and introspection. There is a pervasive difficulty in thinking about thoughts and feelings, both for others and for themselves. The person with AS has immature or impaired ToM abilities or empathy, not an absence of empathy. To imply an absence of empathy is an insult to people with AS, with the implication that the person does not recognize or care about the feelings of others. The person does care, very deeply, but may not be able to recognize the more subtle signals of emotional states or ‘read’ complex mental states.
Typical people ‘mind read’ relatively easily and intuitively – they can ‘read’ a face, translate the meaning of body language, the prosody of speech, and recognize the contextual cues that indicate the prevailing or expected thoughts of others. Impaired ToM skills in AS people consist of:
Difficulty reading the social/emotional messages in someone’s eyes. Autistic people engage in less eye contact, tending to look at a person’s face less often, and therefore missing changes of expression. Typical people focus on the eyes to determine thoughts and feelings – they are the window to the soul. AS people look more at the mouth, body, and objects. Looking at the mouth processes linguistic communication but misses information expressed in the eyes. Even when they look at the eyes, they are less able to read the meaning in the eyes. “People give each other messages with their eyes, but I do not know what they are saying”.
Making a literal interpretation is one of the impaired or delayed ToM skills. They also have difficulty understanding the significance of the person’s tone of voice, or prosody which normally would enable the listener to go beyond a literal interpretation, to realize when someone is teasing or being sarcastic. They can be remarkably gullible and assume that people say exactly what they mean.
Humour. Many people with AS have a unique or alternative perspective on life that can be the basis of comments that are perceptive and humorous. It is not a sense of humour that AS people lack, but rather the social skills to recognize when others are joking, signal that we are joking, or appreciate jokes which rely on an understanding of social conventions.
Some adolescents with AS can be remarkably imaginative in creating original humour and jokes but the topic is often related to the special interest and may not be created to share the laughter with others. Many teenagers with AS create abundant jokes, although it is not always obvious what you are supposed to be laughing at. However, the laughter of the person with AS in response to an idiosyncratic joke is very infectious.
Being considered rude and disrespectful
They may not notice subtle cues that others are becoming annoyed with their egocentric or dominating behaviour or conversation. They appear to break the social rules and don’t respond to warning signs. Typical people make a moral judgment that the child is being deliberately disrespectful and rude, even though there is no malicious intent, and are simply unaware of offending. They then become bewildered as to why the other person is angry.
People with AS have a remarkable enthusiasm for their special interests. They may not recognize that other people do not share the same level of enthusiasm. As AS people tend to look less at the other person when they are talking, they may not see or recognize the subtle signs of boredom or to be able to recognize is relevant to the context of priorities of the other person.
When a mother asks “What did you do at school today?”, the AS child may have difficulty identifying the key events from a mother’s perspective and will either refuse to answer the question as it is too difficult or provide a commentary of the whole day, with every detail. The monologue then becomes very tedious. When asked what they would like to eat or drink when at another person’s home as a guest, it may be impossible to answer. “What is available?” Once the options are laid out for them is it easy to make a choice. Otherwise, the question just feels too big.
Equally, those topics or activities that are of interest to others may be perceived as boring by the person with AS. This is due to impaired ToM rather than a lack of respect or a desire to misbehave.
Honesty and deception
Young children with AS are often remarkably honest. Typical children recognize that there are some occasions when the adult would not have enough knowledge and the child can use deception to avoid the consequences. AS people do not know that they are expected to tell a ‘white lie’, commenting on someone’s true but likely to cause offence. Other children would normally inhibit a response, based on an understanding of the other person’s thoughts and feelings. AS children and adults have a greater allegiance to honesty and truth than to the thoughts and feelings of others.
The ability to understand the value of deception and recognize when it might be expected occurs later in the development of the child with AS, sometimes as late as the early teens. This confuses parents and teachers, as the previously honest (perhaps to a fault) child recognizes that one can deceive people and avoid anticipated consequences. However, the type of deception can be immature and deceit easily identified by an adult.
If lying becomes an issue, due to impaired ToM, the person with AS may not realize that the other person is more likely to be more offended by the lie than by any apparent misdemeanour. They may consider that a lie can be a way of avoiding consequences or a quick solution to a social problem. What the person might not acknowledge is that lying can also be a way of maintaining self-esteem should they have an arrogant self-image, whereby the making of mistakes is unthinkable.
Adults with AS can be renowned for being honest, having a strong sense of social justice, and keeping to the rules. They strongly believe in moral and ethical principles. These are admirable qualities in life but can cause considerable problems when the person’s employer does not share the same ideals. Possibly many whistle-blowers have Asperger’s syndrome. If they have applied a company’s or government department’s code of conduct to their work and reported wrongdoing and corruption, they may be subsequently astounded that the organizational culture, line managers, and colleagues have been less than supportive; this can lead to disillusionment and depression.
A sense of paranoia
Impaired ToM skills make it difficult to distinguish between the deliberate or accidental actions of another person. The apparent paranoia might also be due to a very real social experience when they encounter a greater degree of deliberate and provocative teasing than their peers. Once another child has been hostile, any subsequent interaction with that child with AS can assume that the interaction was intentionally hostile, while typical children would be better able to interpret the other child’s intentions by the context and social cues.
Problem-solving. When presented with a problem, seeking guidance from someone who probably knows what to do is usually not a first or even second thought.
Managing conflict
As children develop, they become more mature and skilled in the art of persuasion, compromise, and management of conflict. They are increasingly able to understand the perspective of other people and how to influence their thoughts and emotions using constructive strategies. Managing conflict successfully requires considerable ToM skills.
Children with AS are relatively immature, lack variety in negotiating tools, and tend to be confrontational. They may resort to ‘primitive’ conflict management strategies, such as emotional blackmail or an inflexible adherence to their point of view. They may fail to understand that they would be more likely to achieve what they want by being nice to the other person. When an argument or altercation is over, less remorse, or appreciation of repair mechanisms for other people’s feelings, such as an apology.
During adolescence, the child is expected to be able to compromise, identify and acknowledge the point of view of the other person, negotiate and forgive and forget conflicts. These attributes can be elusive for the child with AS, who can be considered as displaying signs similar to Oppositional and Defiant Disorder.
The relevant conflict resolution characteristics associated with Asperger’s syndrome at this stage are:
• a difficulty conceptualizing the other person’s perspective and priorities
limited skills in persuasion
• a tendency to be confrontational and rigid
• reluctance to change a decision and admit making a mistake
• an aversion to being interrupted
• a compulsion for completion
• a tendency to punish rather than praise
• a tendency to avoid demands
• a lack of knowledge of alternative strategies
Thus children with AS can appear to oppose the decisions of others, defy their priorities, and deny their reason. They may have a history of pursuing their decision until the other person capitulates, and not recognize the signals that it would be wise not to continue the argument.
They need guidance in when and how to make a request, to listen to and absorb the point of view and priorities of the other person, to negotiate some areas of agreement and compromise, and to seek and accept the decision of an adjudicator. Above all, they need to learn not to let emotions, especially anger, inflame the situation.
Introspection and self-consciousness
Due to poor ToM skills, AS people may develop a different form of self-consciousness. They may acquire ToM abilities using intelligence and experience rather than intuition as they reflect on their own mental state and the mental states of others (like a philosopher). When a different way of thinking and perceiving the world is combined with advanced intellectual abilities, we achieve new advances in philosophy. The philosopher Ludwig Wittgenstein has many of the characteristics of an intellectually ‘gifted’ person with AS.
Understanding embarrassment. Children with AS tend to rate some situations as embarrassing whereas typical children do not, and they have some difficulty justifying why someone would be embarrassed. At an intellectual level, they have an understanding of the concept of embarrassment but are less able to use the concept in novel situations. They can appear to have little embarrassment or ‘stage fright’ when making a presentation or acting in front of others. They make fewer gestures of embarrassment (such as a hand over the mouth, or a red face) than their peers.
A faux pas is defined as ‘an indiscreet remark or action’, and children with AS are less skilled at detecting faux pas and more likely to commit a faux pas in their everyday behaviour.
Children at around 8 years can inhibit their comments or criticism on the basis of their prediction of the emotional reaction of the other person, that is, they keep their thoughts to themselves so as not to embarrass or annoy their friend. The person can be very astute as identifying mistakes and can be very keen to point out another person’s mistakes. The comments can be interpreted as deliberately critical and hostile, but the motivation of the AS person may have been to encourage perfection and to enlighten the other person about the error. Teenagers with AS may criticize the teacher in front of the whole class. The teacher’s mistake may have been trivial, such as the incorrect spelling of a word, but the desire to correct the mistake takes precedence over the feelings of the teacher.
Anxiety
Being unsure of what someone may be thinking or feeling can be a contributory factor to general feelings of uncertainty and anxiety. Because of a lack of confidence, they may be afraid of upsetting others without realizing it or meaning to, by saying or doing the wrong thing. They wish they could read minds and then would know what others wished for and they could do the right thing. What works for them doesn’t work for others. People don’t always say what they mean or stick to what they say.
The speed and quality of social reasoning
Typical people are very quick and efficient in using ToM abilities when engaged in social situations. While people with AS can demonstrate quite advanced ToM skills, they can take longer with the cognitive processing of the relevant cues and responses than one would expect, and require more encouragement and prompts. The answers to questions can be less spontaneous and intuitive and more literal, idiosyncratic, and irrelevant.
One of the consequences of using conscious mental calculation is the effect on the timing of responses. This can lead to a lack of synchrony to which both parties try to adjust. The person with AS can be perceived as unusually formal or pedantic, or even to be considered intellectually retarded. Other children may call AS children stupid, which adds insult to injury and can lead to low self-esteem or anger. ToM abilities can be influenced by the complexity of the situation, the speed of the interaction, and the degree of stress. In large social gatherings, the amount of social information can be overwhelming with difficulty determining which signals are relevant and which are redundant, especially when inundated with social cues.
The time taken to process social information is similar to the time for someone who is learning a second language. If the native speaker talks too quickly, only a few fragments may be understood. Others may learn to adjust their interactions with a person with AS to be within the person’s processing capacity for social reasoning.
When relaxed, the person with AS can more easily process mental states, but when stressed, as with any skill, performance declines. This may explain the difference between formal knowledge in an artificial testing situation, and real life, which is more complex, with transitory social cues and greater stress.
Exhaustion
Recognize the degree of mental effort required to process social information. Using cognitive mechanisms to compensate for impaired ToM skills leads to mental exhaustion. Limited social success, low self-esteem, and exhaustion can contribute to the development of clinical depression – “I’m all peopled out.”
STRATEGIES TO IMPROVE THEORY OF MIND ABILITIES
Social Stories. They describe each person’s knowledge, thoughts, beliefs, and feelings that are relevant to individual situations, especially for the child with AS. It is a training program specifically designed to improve social cognition.
Comic Strip Conversations. They use simple stick figure drawings, thought and speech bubbles, and text to illustrate a sequence of actions, emotions, and thoughts in a specific social situation. Colour can be used to identify the emotional tone or motivation. This provides an opportunity to learn the child’s perception of the event and to correct any misinterpretations by having a conversation between the child and the adult. They provide a clear visual explanation of what someone is feeling and thinking. Children with AS often communicate their thoughts and feelings more eloquently using drawings rather than speech. Estimating the degree of expression of a particular emotion can be very ‘black and white’ without understanding the shades of grey and comic strip Conversations uses a numerical scale from one to ten.
Teaching Children with Autism to Mind-Read is a guide for teachers to understand informational states, emotions, and pretense.
Mind Reading: The Interactive Guide to Emotions is a remarkable interactive DVD with an electronic encyclopedia of 412 emotions in 24 different groups. It is very useful for children and adults with AS.