Does the autistic child have a theory of mind

Abstract We use a new model of metarepresentational development to predict a cognitive deficit which could explain a crucial component of the social impairment in childhood autism. One of the manifestations of a basic metarepresentational capacity is a ‘theory of mind’. We have reason to believe that autistic children lack such a ‘theory’. If this were so, then they would be unable to impute beliefs to others and to predict their behaviour. This hypothesis was tested using Wimmer and Perner's puppet play paradigm. Normal children and those with Down's syndrome were used as controls for a group of autistic children. Even though the mental age of the autistic children was higher than that of the controls, they alone failed to impute beliefs to others. Thus the dysfunction we have postulated and demonstrated is independent of mental retardation and specific to autism.

Does the Autistic Child Have a''Theory of Mind''? Cognition

In previous tests of the lowest level of a "theory of mind" (i.e. first-order belief attribution), 80% of autistic children were found to be impaired relative to a non-autistic mentally-handicapped control group. The present study examines the 20% of autistic children who have a theory of mind at the lowest level, and tests their ability to use a theory of mind at higher levels (i.e. second-order belief attribution). This autistic subgroup, in comparison to Down's Syndrome and normal control groups, was found to be severely impaired at the higher level. Autism is discussed as a possible case of specific developmental delay.

The autistic child's theory of mind: a case of specific developmental delay

Diagnosis and definition of childhood autism

• We analyze the behavioral and motor disturbances in childhood autism. On the basis of analogy to signs and conditions seen in adult neurology, we propose that the syndrome results from dysfunction in a system of bilateral neural structures that includes the ring of mesolimbic cortex located in the mesial frontal and temporal lobes, the neostriatum, and the anterior and medial nuclear groups of the thalamus. The mesolimbic cortex is cytoarchitectonically, angioarchitectonically, and neurochemically distinct and, along with the striatum, forms the entire target area of dopaminergic mesencephalic neurons. This raises the possibility that autism is related to neuromediator imbalance in those structures. Such dysfunction might be the result of macroscopic or microscopic changes in the target area or in structures functionally influencing them, consequent to a variety of causes such as perinatal viral infection, insult to the periventricular watershed area, or genetically determined neurochemical abnormalities.

A Neurological Model for Childhood Autism

The case histories of 9 autistic children, 8 boys and 1 girl, selected from a total of 96 so diagnosed at The John Hopkins Hospital prior to 1953, are presented in some detail and discussed. These children, first evaluated and given the diagnosis at an age ranging from 2 years and 10 months to 8 years and 1 month, are presently in their 20's and 30's. Their development is traced from acute psychotic infancy until the end of 1971. Having made a sufficient social adjustment, they manage to function as self-dependent individuals, mostly well educated and all gainfully employed. Attention is drawn to differences between this group and other autistic patients, maturational and environmental issues as well as to past and present patterns of behavior and personality structure.

How far can autistic children go in matters of social adaptation

SUMMARY

A prospective study was made of 200 consecutive children to evaluate the usefulness in the diagnosis of infantile autism of the behavioral scale reported by Clancy and coworkers in 1969. On this scale seven or more of 14 behavioral manifestations must be present before a diagnosis of autism can be made. Using this scale alone, 48 of the 200 children studied were ‘scale positive’, i.e. could be considered autistic. However, further study of this group showed that only one child fulfilled the classical criteria of Kanner (1943) for a diagnosis of early infantile autism. Scale ‘positivity’ was found to correlate with mental retardation and to be associated with other developmental defects, especially learning disorders and hearing loss.



ZUSAMMENFASSUNG

Kindlicher Autismus. I: eine prospektive Untersuchung der Diagnose Bei 200 Kindern wurde eine prospektive Studie durchgefuhrt, um die Anwendbarkeit einer Verhaltensskala, die 1969 von Clancy und Mitarbeitern veroffentlicht wurde, zu beurteilen. In dieser Bewertungsskala wurde gefordert, das sieben oder mehr von 14 Verhaltensmustern vorhanden sein mussen, um die Diagnose Autismus zu stellen. Wenn man nur diese Bewertungsskala benutzte, waren 48 der 200 Kinder ‘positiv’, d.h. konnten als autistisch angesehen werden. Wenn jedoch intensivere Untersuchungen dieser Gruppe durchgefuhrt wurden, entsprach nur ein Kind den klassischen Kriterien von Kanner (1943) fur die Diagnose des fruhkindlichen Autismus. Positivitat in der Verhaltensskala wurde korreliert mit geistiger Retardierung und mit anderen Entwicklungsstorungen besonders Lernschwierigkeiten und Horverlust in Verbindung gebracht.



RESUMEN

Autismo infantil. I: un estudio prospective) del diagnostico Se realizo un estudio prospectivo de 200 ninos consecutivos, para evaluar la utilidad de una escala de comportamiento descrita por Clancy y col. en 1969. Con esta escala se dijo que siete o mas de 14 manifestaciones de comportamiento pueden hacerse presentes antes de que pueda realizarse el diagnostico de autismo. Utilizando solo esta escala, el 48 de los 200 ninos eran escala ‘positivos’, esto es, podrian ser considerados como autisticos. Sin embargo, cuando se aplico al grupo un estudio mas intensivo, solo un nino cumplio los criterios clasicos de Kanner (1943) para un diagnostico de autismo infantil precoz. La positividad a la escala se relaciono con retardo mental y fue asociada con otros defectos del desarrollo, especialmente alteraciones en el aprendizaje y perdidas de audicion.

Alejandro Rodriguez

Papers

How far can autistic children go in matters of social adaptation

Fantile Autism. I: A Prospective Study of the Diagnosis