Autism: The theory of mind Dogma

[andy]

Any good theory can generate good ideas. As a clinician I have quite frankly witnessed both 'left' and 'right' wing views of the TOM. By right wing I mean a deficit model. That is, 'this person cannot think this way because they do not have the modulle in their brain to do x or y'. This in my opinion verges on dogma. It is based on a deficit model. Think about the damage a deficit model can do? Try IQ as an example. More left wing view in my opinion suggest that people 'have difficulties understanding' this is not just a question of semantics.


What do you think about TOM?

[ged]

I think lack of TOM is absolutely the crux of autism. I think the triad are secondary characteristics which are caused directly by an impaired TOM.

But the thing about autism is it is a SPECTRUM disorder. Luke Beardon talked about the different aspects of autism being like sliders on a stereos graphic equaliser, with each slider representing a different core characteristic of autism. (If enough of the sliders point to ASD and not NT then you are on the spectrum)

One of these sliders must be TOM, (others could be polar thinking, OCD like behaviour, I'm open to suggestions). So what I am saying in a long winded way, is that yes, just coz they are on the spectrum doesn't mean that the TOM is completely absent. That slider may be pointing close to neuro-typical.

I read an article, I think it was by Simon Barron-Cohen, which took brain scans (MRI?) of people with a diagnosis of Asperger syndrome whilst asking them complicated versions of the Sally Ann question *, the classic TOM test used with kids. They could answer it fine, but they were using the deductive part of the brain, which suggested that they worked it out like a maths problem, rather than instinctively, like the NT's did.

If they have to conciously work out what beliefs someone else may hold, even though they may arrive at the correct answer, its going to be labourious and possibly clumsy, with errors inevitably creeping in. It would also answer why people TOM gets worse, the more tired or stressed they are. I'm crap at maths when I'm shattered.

So TOM, like any core value/characteristic of ASD can vary both throughout the population, and in the individual over time, dependent on mood and environment.

Andy, TOM is fairly easy to prove, can you not ask the clinicians who subject their clients to black and white thinking ;) to test their assumptions? I've found people with Aspergers love proving professional wrong. :)

GEd

*Whats the name for this kind of question? I'm thinking "substituted judgement", but I know thats wrong...

[anon_e-mouse]

For a good discussion article try the Autism Information library
it will also explain some of the common shorthand eg NT "neurotypical," i.e. a person with typical neurology, or a "normal" person. etc..

http://www.autistics.us/library/AE2000-ToM.html

I like the graphic equalizer analogy as an approximation of something that is probably more analog than digital....

Relating to others, empathy and the ability to think from another's perspective are key to understanding this issue.

Being more third way than right or left wing, I am going to side with Andy on preferences for non deficit models also. I feel more comfortable to say that thinking about others is a useful talent that some people have more of than others.

It may even be argued that caring for others and expressing that care in the form of actions is easier and more common in one gender, hence why action originating from thoughts that do not take into account or ignore the effects to others is more pronounced in men and boys. (maybe another discussion on crime and violence in that statement!)


the fact that we are discussing this shows that the participants here have a developed talent in this area.

But this is not new thinking even if the western TOM label is a relatively new for a theory with roots deep in other cultures

If you delve into Buddhist "precepts" you start to notice that the effort of learning is directed at understanding the connection between thinking and action and the effect on others
eg on morality ".......Is this deed conducive to my harm, or to others' harm, or to that of both? Then is this a bad deed entailing suffering. From such a deed, you must desist......." i use this only as an example of non western thinking and not as a case for lets all study Buddhism!

As theory can generate good ideas what are the relative merits from a clinician or practitioners point of view to the opposing left and right view?

How is TOM helping?

[Good&Evil]

I think lack of TOM is absolutely the crux of autism. I think the triad are secondary characteristics which are caused directly by an impaired TOM.

...

I read an article, I think it was by Simon Barron-Cohen, which took brain scans (MRI?) of people with a diagnosis of Asperger syndrome whilst asking them complicated versions of the Sally Ann question *, the classic TOM test used with kids. They could answer it fine, but they were using the deductive part of the brain, which suggested that they worked it out like a maths problem, rather than instinctively, like the NT's did.



Going through the literature (that I have access to and time to go through) I often get the feel that researchers tend to go for those areas on autism that are 'more easily researchable'. By this I mean that the sample groups often tend to consist of verbal, relatively high functioning (or Asperger's as in the study you are quoting) and of a measurable IQ. I know that this is often essential for sake of finding an adequate control group but a good part of the clients that as a practitioner I work with have autism but have a very low level of functioning.

TOM IMHO is an easily researchable area that might be getting too much hype in the area of PDD and autism at the moment. I see how TOM might affect a person's development in other domains, but I somehow get the feel that ASD deficits might revolve around more basic areas (like problems in the child's ability to establish a dyadic relationship with those around him/her??).

[andy]

One is the issues that have with the research is the so called 'Sally Ann test'. This test demonsrates that people with ASD struggle taking the perspective of others. This is trying to prove a negative result rather than a positive one. In mainstream developmental psychology Paigetian developmental thoery was based on tests which demontrated childrens inability to understand particular constructs until they were ready to do so developmentally. A leading Researchers Margaret Donaldson in her book 'Childrend Minds' as early as the 1980's demonstarted that children could pass tests if they were presented in different ways. My warning is that, the results of specific tests to support a theory is quite dodgy science. Incidentally, there are as limited number of studies reporting that TOM is demonstrated to be present in non autistic populations, what on earth does that mean. In conclusion TOM is a useful construct but, we need to avoid the validity of some of the critical tests.

[ged]

I don't doubt that the Asperger population are easier to research than classical autistic people, I guess the hope is that the lessons learnt are transferable.

To draw back from academia, an important question for me is does the theory aid my understanding of my clients.

Example:

The building I work in has some armchairs which are underneath a sloping roof. As I was getting up one day I absolutely clouted my head on the corner. There were tears in my eyes, I cursed, I rolled about on the floor moaning. A lady I work with, with a diagnosis of aspergers saw me, and asked me over and again why I was doing what I was doing. When I explained to her that I had hit my head, that it really hurt, and that maybe she could try a little sympathy, she was then on board, and knew exactly how to act in that situation.

I think that a developed TOM would have allowed her to understand my actions of rolling about on the floor clutching my head and to independently find a socially appropriate response. Because I assumed that her repeated demanding questions were because she could not know or guess what I was feeling, I explained what I was feeling.

If I discount TOM then I'm left with the assumption that she either had no empathy at all, or knew what I was doing but was just callus.

If I understand the reasons for a behaviour, I'll find it less challenging, and I may be able to alter my behaviour to reduce the frequency of it. TOM is just another tool, use it if it works, if not, don't!

As for lack(?) of TOM in the NT population, I'd refer back to Lukes sliders. You could have one slider pointing at autistic, but if the rest are at NT, you'll get through life just fine being very single minded. Thats not accounting for an undiagnosed population.

Ged

[anon_e-mouse]

Interesting
"does the theory aid my understanding of my clients?"
It obviously does as the theory trys to make sense of how we understand others. (not how to...)

"Interpreting other people’s actions and intentions involves a mutual ascription of content full mental states such that the understanding of the social world around us becomes coherent and intelligible."

if by choosing a set of beliefs about the behavior of you are less emotionally strained and the behavior is better tolerated and therefore less challenging.

I like the idea if it works use it.

BUT
Do you need to dress it up as a clinical psycho speak theory of mind or just accept that it is possible that some people understand others actions and intentions better than others? If you are talking to people employed to care for others and explaining to them why Johnny does this and Jenny does that, many are not too impressed by a theory but want a practical explanation.

Eg you rolling around on the floor clutching your head is understandable since you just banged it and your head hurts.

compared to
my client just punched me in the face broke my glasses
he doesn't understand that this hurt me and makes me feel bad. He would feel bad and feel pain if it happened to him but translating his own experience onto others having a similar feeling is not automatic.

Anyone got any similar stories of how they have explained why Johnny and Jenny do what they do from a TOM point of view without mentioning TOM?

Its a good challenge to work out how to explain something in a simple language that staff can understand.



More resources for beginners
another angle on "False belief task" which also explains the sally Anne test
http://staff.science.uva.nl/~michiell/docs/dwood_fb2002.pdf

TOM:
http://en.wikipedia.org/wiki/Theory_of_mind

[dave]

Theory of mind ? The great philosopher Gilbert Ryle once said 'what is matter I do not mind, what is mind does not matter'. I think we do need to understand that theories can be useful without necessarily being factually correct.