Theory of mind refers to the ability to understand the desires, intentions and beliefs of others, and is a skill that develops between 3 and 5 years of age in. Partial correlations (controlling for age and verbal IQ) between theory of mind and broad social communication impairments in children with Autism Spectrum. We often hear or read that those with autism lack “Theory of Mind” (ToM). In short, ToM allows us to understand and predict the behaviors of Finally, reciprocity (the give-and-take, mutual benefit of a relationship) may be.
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However, few studies have shown evidence for their effectiveness. The results showed that, compared to controls, the treated children with ASD improved in their conceptual ToM skills, but their elementary understanding, self reported empathic skills or parent reported social behaviour did not improve. Despite the effects on conceptual understanding, the current study does not indicate strong evidence for the effectiveness of a ToM treatment on the daily life mindreading skills.
Autism, Treatment, Theory of Mind, Social cognition, Randomized controlled trial Introduction Theory of Mind is the ability to attribute subjective mental states to oneself and to others Baron-Cohen et al.
Following the great number of studies that have established this impairment Yirmiya et al. Despite these efforts, little is known about whether, when, where and for whom these treatment programs work in autism Koenig et al.
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- Autism and Theory of Mind
Research to date is hampered by small samples, the absence of randomized controlled trials, and poorly designed outcome measures Smith et al. Large scale, randomized controlled trials RCTs are rare in autism, even when considering the wider domain of social skills training.
Several recent reviews of studies on social skills treatment indicate that programs are often not even based on manual curricula, and fail to identify primary outcome measures Seida et al. Given the variation in the nature of both treatment and outcome variables, it is unsurprising that the empirical support for the effectiveness of social skills training in autism is regarded incomplete.
However, currently available evidence is generally regarded positive, and these programs continue to be used widely Reichow and Volkmar ; Rao et al. Considering the more narrowly defined Theory of Mind training programs, one might expect clearer treatment programs and outcome measures.
All programs focus children on the internal, subjective mental representations of themselves and those around them. When considering this overlapping construct, a next question is what outcome measures are sensitive to change and clinically relevant to the construct of Theory of Mind Smith et al.
While Theory of Mind research initially relied on behavioural tasks in primates Premack and Woodruffmost studies with children are characterized by a strong focus on conceptual measures. Theory of Mind is usually also linked, and sometimes even identified with tasks that focus on emotion recognition Baron-Cohen et al. However, when considering the function of Theory of Mind, which involves the mastering of social situations, it is surprising to find so little research on how individuals actually use their Theory of Mind skills in social interactions Begeer et al.
Applied or naturalistic measures of advanced Theory of Mind have also used videotaped social interactions or emotional expressions, which may be suitable as outcome measures Golan and Baron-Cohen The training, based on Swettenham et al.
The second RCT showed the effect of a computer program for training emotion recognition. The relationship between social synchrony and facial emotion recognition has not been previously evaluated. If ToM and social synchrony share underlying circuitry, one would expect that synchrony would not be related to facial emotion recognition.
In addition, we compared performance of adolescents with and without ASD on a ToM animations task and emotion recognition task, and expected to replicate previous research findings of Campbell et al. Namely, we expected that adolescents with ASD would be less able to accurately make mental attributions of animated movements or recognize facial emotions.
Materials and Methods Participants The participants consisted of 18 adolescents paired with a parent. Nine adolescents had a diagnosis of autism 8 males, 1 female, average age The participants were matched for chronological age. The WASI is a short reliable measure of intelligence and is nationally standardized and we used the matrix reasoning and vocabulary subtests. Participant characteristics and clinical phenotyping. The ADOS is a semi-structured, standardized assessment of communication, social interaction, and play for individuals referred because of possible autism.
It is comprised of five modules — a toddler module for children between 12 and 30 months of age, and four modules appropriate for use with individuals of varying language levels and age; these range from Module 1, intended for young children who are non-verbal or using mostly single words, Module 2, intended for children of any age who use phrase speech, Module 3, intended for verbally fluent children and young adolescents, and Module 4, intended for verbally fluent older adolescents and adults.
The ADOS subscores for communication, social interaction, and stereotyped behaviors and restricted interests, as well as the communication and social interaction total, are reported.
Five participants were administered Module 3 and 13 were administered Module 4. Parents provided written, informed consent for children to participate, parents signed releases to consent to video recordings, and adolescents gave their assent to participate.
The study was conducted over two visits and the first visit took approximately 3 h while the second visit took approximately 1. Participants were recruited from local communities through print advertising, a recruitment brochure, email, social media, and community events.
Recruitment material was posted on various community and University of Massachusetts Medical School websites. Clinical and Social Measures There were two separate experimental sessions, completed approximately 1-week apart. In the first session, screening for medical and psychopathology was conducted. Each of these measures is described below. Social Responsiveness Scale The Social Responsiveness Scale SRS; Constantino and Gruber, is a item rating scale that measures the severity of autism spectrum symptoms as they occur in natural social settings.
It is appropriate for use with children from 4 to 18 years of age. The SRS is completed by a parent in 15 to 20 min. We used the SRS t-score in the current study. The ADHD inattention, hyperactivity, and total scores were used in the data analysis. In this paper, the following subscales, related to ASD traits, were used: It is appropriate for use in children 4 years or older. The overall SCQ summary scores was used in the data analysis. Experimental Tasks and Procedure In the second visit, three experimental tasks social synchronization, ToM, and recognition of facial emotions were completed.
The spontaneous synchrony task was completed at the start of the experimental session to prevent experimental task demands from influencing performance and the order of presentation of the in-phase and anti-phase intentional synchrony trials was counterbalanced across participants.
Presentation software Neurobehavioral Systems Inc. The data collected for this study was part of a larger project investigating differences in spontaneous and intentional synchronization abilities of adolescents with and without ASD Fitzpatrick et al.
Here, we used three of the measures from Fitzpatrick et al. Experimental Tasks Social Synchronization Tasks The social synchronization tasks involved adolescent-parent pairs swinging hand-held pendulums while the movement time-series of the pendulums was recorded. During the intentional synchrony task, participant pairs coordinated their pendulum swinging with their partner in either an in-phase pattern so their pendulums were in the same portion of their cycles at the same time or anti-phase pattern so that their pendulums were in opposite portions of their cycles at the same time.
Additional details about the task and calculation of the synchrony measure circular phase variance can be found in Fitzpatrick et al. The 12 animations originally used in Abell et al. Responses were measured with the objective multiple-choice test developed by White et al. The maximum score for each animation type was 4. After the ToM animations, participants were presented with two additional questions MCQ Feelings to choose the adjective that best described the feelings of the small and large triangles.
What is Theory of Mind and How Does it Relate to Autism?
The maximum score was 8, corresponding to two possible correct answers for each of the 4 animations. The percent correct was calculated for the four ratings goal-directed, random, ToM, MCQ Feelings and used in data analysis. Facial Emotion Recognition Task Recognition of facial emotions was measured using a modified Ekman 60 faces test Ekman and Friesen,especially designed for use in individuals with ASD. The participant was instructed to watch a presentation of the stimuli from four picture conditions angry faces, fearful faces, neutral faces, and housesall presented in an oval cutout.
A blocked design paradigm, with eight items per block 1 repetition, somewhere at random within block was used. Participants were asked to respond by pressing the space bar whenever the item was repeated—there was always one per block. Each active block was 20 s, each rest block was 16 s, and there were two blocks per condition across three runs.
Reaction time was recorded and the number of hits was calculated for the four picture conditions anger, fear, neutral faces, and houses.
Diagnostic group was a between-subjects variable and animations rating condition was a within-subjects variable. Diagnostic group was a between-subjects variable and picture condition was a within-subjects variable. Data from both groups adolescents with and without ASD were included in these analyses to explore the relationships evident across a broader range of skills. In addition, an exploratory factor analysis was conducted to further explore the underlying relationships between these variables.
Results Group Differences in Clinical Phenotyping As seen in Table 1independent samples t-tests revealed significant group differences for all the clinical phenotyping measures except for the ADHD Inattention scale.
Theory of Mind Training in Children with Autism: A Randomized Controlled Trial
Neither the animations condition nor the interaction was significant. For the control group, there were no significant differences in performance on any of the animation conditions.
Significant group differences in performance on the animations task was due largely to significantly worse performance by adolescents in the ASD group on the MCQ Feelings condition than control participants, no significant group differences were found for the other animations conditions. Participants in the ASD group were significantly better in the random movements condition than the MCQ Feelings condition but the performance of control participants was equivalent for all animations conditions.
Participants with ASD performed worse than the control participants in all three picture conditions with faces. Performance was equivalent between groups for the pictures of houses. As seen it Table 2none of these correlations were significant.
There was one significant correlation between one ToM control task GD ToM and one control emotion recognition task neutral face. Circular phase variance during spontaneous entrainment was not significantly correlated with any of the emotion recognition tasks. Intentional Coordination In order to evaluate the relationship between intentional synchronization and more traditional measures of social skills clinical scales and experimental measures of ToM and emotion recognitiona composite score of circular phase variance for all three pendulum conditions was calculated for both in-phase and anti-phase.
Bivariate correlations were conducted with circular phase in-phase and anti-phase composite scores. In addition, there were significant correlations with the ADOS communication and social interaction subscales, but not the stereotyped behaviors and restricted interests.
MCQ Feelings was significantly correlated with in-phase synchronization but no other ToM or emotion recognition correlations were significant. Factor Analysis In order to determine whether there were latent factors or components underlying the correlations between variables measuring different aspects of social abilities, a principal components factor analysis was conducted.
Some behaviors were measured multiple ways so we chose the measure that best differentiated the groups for inclusion in this analysis. The performed factor analysis satisfied several adequacy criteria.
Autism and Theory of Mind | The Autism Blog
First, all items correlated at least 0. Second, the Kaiser—Meyer—Olkin measure of sampling adequacy was 0. Additionally, the communalities were all above 0. A principal components factor analysis using varimax orthogonal rotation found that the three factors explained The loadings less than 0. The results of this solution are shown in Table 5. Four items, the intentional synchronization, communication, attention, and social responsiveness loaded onto factor 1 and explained This factor seems to be indexing social action and attention aspects of social skills.
Two items, ToM and spontaneous synchrony, loaded onto factor 2 that explained and additional This factor seems to be indexing more implicit social knowledge that arises from viewing actions in the case of ToM or performing actions with another person. Interestingly, the intentional synchrony measure loaded on the social action factor while spontaneous synchrony loaded on a separate factor, suggesting that intentional and spontaneous synchrony may contribute to social interactions in different ways and perhaps have different underlying mechanisms.
The final factor was comprised of three items, IQ, communication, and social responsiveness, and explained an additional This factor could be characterized as social communication and seems to involve somewhat higher order cognitive abilities.
In contrast, social action appears to depend more on attention processes. Discussion Overall, our results indicated that adolescents with ASD had difficultly ascribing appropriate feelings to ToM animations, although they were equivalent to controls in their ability to detect that a mental state was represented in the ToM animations.
What is Theory of Mind and How Does it Relate to Autism?
In addition, adolescents with ASD performed worse than the controls on facial emotion recognition in terms of accuracy but their reaction times were similar to controls. Interestingly, we found significant relationships between both spontaneous and intentional synchrony and the ability to accurately ascribe feelings in the ToM animations.
Intentional synchrony was also related to autism severity, social responsiveness, and attention. In contrast, facial emotion recognition was not correlated with spontaneous or intentional synchrony, nor was emotion recognition related to ToM performance.
Furthermore, the principal components analysis resulted in intentional and spontaneous synchrony loading on different factors, suggesting these two types of synchronous behavior tap into different dimensions of social skill that might have different underlying mechanisms.
Our findings suggest intentional synchrony shares mechanisms with attention, social communication, and social responsiveness while spontaneous synchrony shares mechanisms with ToM. Facial emotion recognition appears to be dissociated from both of those aspects of social behavior.
Our findings replicated Campbell et al. We also demonstrated that in our sample of adolescents with and without autism, there was no relationship between ToM and emotion recognition. This is consistent with other research Shamay-Tsoory et al.