“Theory of Mind” (ToM) is often misunderstood.  It’s about whether you can recognise what you and others are thinking and feeling in different situations.

You need a Theory of Mind to understand what you want and feel; and what others want and feel.  People without it have significant social problems communicating with others.  ToM gaps are most associated with people with autism spectrum disorder (ASD).  But other people have ToM gaps, too e.g. some people with:

There’s a lot of confusion about what ToM means, how it develops and how to help people with ToM gaps.  This article addresses these questions by reference to recent research.

1. What is theory of mind (ToM)?

Back in the 1970s, “theory of mind” was a pretty simple idea.  It meant a person’s ability to assign a mental state to himself or herself; and to others.  We’ll call this “Traditional ToM”.

Nowadays, we know it’s more complicated.  There are different kinds of ToM:

  • Traditional ToM; and
  • Affective ToM: thinking about and experiencing the emotions of others.

There are sub-categories of Affective ToM, too:

  • Cognitive Empathy: recognising the emotions of oneself and others; and
  • Affective Empathy: the ability to feel as others are feeling.

To confuse things further, some researchers divide ToM into:

  • Self-directed ToM: thinking about and reflecting on your own thoughts and feelings; and
  • Others-directed ToM: thinking about and reflecting on others’ thoughts and feelings.

2. When does ToM start to develop?

With typically developing children, we used to think Traditional ToM emerged between the ages of 4 and 5.

We now think ToM starts to develop from birth, when we start to copy our parents’ facial expressions.  At some point, toddlers and pre-schoolers realise they are separate from others.  They then develop the skills to pin feelings and thoughts to themselves and others.  Activities like pretend play and story-acting play a role in helping children develop ToM.

3. What are the main stages of ToM development in typically developing children?

  • First Order ToM: between 4-5 years of age, children develop the ability to think about what someone else is thinking or feeling.
  • Second Order ToM: by around 7 years of age, children start to think about what others are thinking or feeling about what someone else is thinking or feeling.
  • Higher Order ToM: between 8 and 12 years of age, children start to recognise others’ lies, sarcasm, figurative language, idioms and “multiple embeddings”, e.g. “He thinks that she hopes that she believes they love the gift”.

4. How is ToM assessed?

No standardised assessments exist yet for ToM.

Testing for Traditional ToM focuses on a person’s understanding of what another person thinks, knows, believes or intends to do.

In the most common test, you show a child two dolls: Sally and Anne.  You then tell the child this story:

“Sally has a basket and a marble.  Anne has a box.  Sally puts the marble in her basket.  Then she leaves the room.  While she is away, Anne takes the marble from the basket and puts in her box.  Sally comes back.”

You then ask the child where Sally will look for the marble.  The child passes the test if she says that Sally will look in her basket (where she put the marble).  The child fails the test if she says Sally will look in Anne’s box (where the child knows the marble is actually located).  Sally doesn’t know Anne moved the marble.  To pass the test, the child must understand that Sally’s thoughts are different from her own.  She must then use this knowledge to predict the behaviour of someone else based on this understanding.

5. How are ToM gaps treated? What resources are available to help?

  • First Order ToM: The main therapy goal is to help the child recognise emotions.  There are some good DVDs and computer games that do this, e.g. The Transporters, Mind Reading and the free Let’s Face It!.  Many of these programs are designed for people with ASD.  Picture books can also help, e.g. the books of Jan Thomas (e.g. Doghouse), and Eileen Browne (e.g. Handa’s Surprise); and
  • Second Order and Higher ToM: Therapy goals include helping the child to think about what someone is thinking or feeling about someone else.  Goals also include developing higher level language skills to understand what others’ mean when they are not speaking literally.  Explicit teaching of figurative language, including metaphors, idioms and sarcasm can help.  Think-alouds – where the teacher or speech pathologist models their own thinking about a situation and the people in it – can be used to teach ToM skills to students to track their own comprehension as they view pictures or read.  The STAMP Treatment and Superflex: A Superhero Social Thinking Curriculum are designed to help children to regulate their behaviour and become social problem solvers.

6. Clinical Bottom line

ToM is not a simple or single idea.  ToM gaps are common for people with ASD.  But they affect others too.  ToM gaps can cause big social problems.

When helping people with ToM gaps, we need to think about the client’s needs.  We need to look at the client’s life to figure out how to help the client to cope e.g. at home, school and in the community.

Principal source: Westby, C. & Robinson, L. (2014). A Developmental Perspective for Promoting Theory of Mind. Topics in Language Disorders, 34(4), 362-382.

Image: http://bit.ly/1MPCJZH

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

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