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

One of the major developments of the second year of human life is the emergence of the ability to pretend. A child's knowledge of a real situation is apparently contradicted and distorted by pretense. If, as generally assumed, the child is just beginning to construct a system for internally representing such knowledge, why is this system of representation not undermined by its use in both comprehending and producing pretense? In this article I present a theoretical analysis of the representational mechanism underlying this ability. This mechanism extends the power of the infant's existing capacity for (primary) representation, creating a capacity for metarepresentation. It is this, developing toward the end of infancy, that underlies the child's new abilities to pretend and to understand pretense in others. There is a striking isomorphism between the three fundamental forms of pretend play and three crucial logical properties of mental state expressions in language. This isomorphism points to a common underlying form of internal representation that is here called metarepresentation. A performance model, the decoupler, is outlined embodying ideas about how an infant might compute the complex function postulated to underlie pretend play. This model also reveals pretense as an early manifestation of the ability to understand mental states. Aspects of later preschool development, both normal and abnormal, are discussed in the light of the new model. This theory begins the task of characterizing the specific innate basis of our commonsense "theory of mind."

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Pretense and representation: The origins of "theory of mind."

After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.

https://jamanetwork.com/journals/PSYCH/articlepdf/495050/archpsyc_47_6_012.pdf

SCAN. Schedules for Clinical Assessment in Neuropsychiatry.

The prevalence, in children aged under 15, of severe impairments of social interaction, language abnormalities, and repetitive stereotyped behaviors was investigated in an area of London. A “socially impaired” group (more than half of whom were severely retarded) and a comparison group of “sociable severely mentally retarded” children were identified. Mutism or echolalia, and repetitive stereotyped behaviors were found in almost all the socially impaired children, but to a less marked extent in a minority of the sociable severely retarded. Certain organic conditions were found more often in the socially impaired group. A subgroup with a history of Kanner's early childhood autism could be identified reliably but shared many abnormalities with other socially impaired children. The relationships between mental retardation, typical autism, and other conditions involving social impairment were discussed, and a system of classification based on quality of social interaction was considered.

Severe impairments of social interaction and associated abnormalities in children : epidemiology and classification

Patterns of sensory abnormalities in children and adults with autism were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). This interview elicits detailed information about responsiveness to a wide range of sensory stimuli. Study 1 showed that over 90% of children with autism had sensory abnormalities and had sensory symptoms in multiple sensory domains. Group differences between children with autism and clinical comparison children were found in the total number of symptoms and in specific domains of smell/taste and vision. Study 2 confirmed that sensory abnormalities are pervasive and multimodal and persistent across age and ability in children and adults with autism. Age and IQ level affects some sensory symptoms however. Clinical and research implications are discussed.

Describing the Sensory Abnormalities of Children and Adults with Autism.

Background: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a schedule for the diagnosis of autistic spectrum and related disorders and assessment of individual needs. It enables information to be recorded systematically for a wide range of behaviours and developmental skills and is suitable for use with all ages and levels of ability. In addition to helping the clinician to obtain a profile of each individual's pattern of development and behaviour, the DISCO also enables identification of specific features found in autistic spectrum disorders that are relevant for use with established diagnostic systems. Method: This paper describes the historical background of the DISCO, outlines its structure and reports the results of an inter-rater reliability study with parents of 82 children aged 3 to 11 years with autistic spectrum disorder, learning disability, language disorder or typical development. Results: Inter-rater reliability for the items in the interview was high (kappa coefficient or intra-class correlation at .75 or higher). This level of agreement was achieved for over 80% of the interview items.

The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use.

Autism Spectrum Disorders in the DSM-V: Better or Worse than the DSM-IV?.

SUMMARY

Children aged 3–14 on one census day, known to the services for severe mental retardation, or having items of behaviour found in early childhood autism, were identified from the Camberwell register. The children can be divided into 3 groups: (a) 42 with no symbolic play; (b) 23 with stereotyped, repetitive, copying play, (c) 43 who have flexible, varied symbolic play. The last occurs only in children with language comprehension age above the 19 month level, and is seen in less than half of the school-age severely retarded children.



The majority of children with no symbolic play, or with stereotyped play, have marked autistic features or the full autistic syndrome. Only 2 of those with true symbolic play have any behaviour like that found in autism and none has the full syndrome. A small group of children with “repetitive” speech and stereotyped play is identified and the relationship with childhood autism is considered.



The educational implications of the findings are discussed.

Symbolic play in severely mentally retarded and in autistic children

Comprehensive data on the developmental history and current behaviours of a large sample of high-functioning individuals with diagnoses of autism, Asperger's syndrome, or other related disorder were collected via parent interviews. This provided the basis for a taxonomic analysis to search for subgroups. Most participants also completed theory of mind tasks. Three clusters or subgroups were obtained; these differed on theory of mind performance and on verbal abilities. Although subgroups were identified which bore some relationship to clinical differentiation of autistic, Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) cases, the nature of the differences between them appeared strongly related to ability variables. Examination of the kinds of behaviours that differentiated the groups suggested that a spectrum of autistic disorders on which children differ primarily in term of degrees of social and cognitive impairments could explain the findings.

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Judith Gould

Papers

Describing the Sensory Abnormalities of Children and Adults with Autism.

The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use.

Autism Spectrum Disorders in the DSM-V: Better or Worse than the DSM-IV?.

Symbolic play in severely mentally retarded and in autistic children

Are there subgroups within the autistic spectrum? A cluster analysis of a group of children with autistic spectrum disorders.