Our tip of the week is joint attention.
Joint attention is the capacity to focus together with another (e.g. a parent) on something in the world, like an apple or a game. For typically developing children, it starts at about 9 months of age.
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 PreLit early literacy preparation program by MultiLit, 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). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee, and is a Board Member of SPELD NSW.
Some children have difficulties understanding others’ feelings and perspectives. They may have trouble fitting in and making friends, e.g. in the classroom, the school playground, at birthday parties, in team sports, and in other social situations. This can be very worrying for parents.
In this article, we explain how children typically learn to think about others’ thoughts, feelings, wants and motives. We also want to provide you with lots of practical tips and free resources for helping your child to understand others’ thoughts – especially if your child is struggling socially.
1. Understanding others by developing a “Theory of Mind”
To understand that other people have their own thoughts, wants, motives and feelings is also called having a “Theory of Mind” (ToM). Janet Wilde Astington defines Theory of Mind as:
…our understanding of people as mental beings, each with his or her own mental states.”
We use Theory of Mind to explain our own behaviour to others (e.g by telling them what we think and want). We also interpret other people’s speech and behaviour by considering their thoughts and wants.
2. When and in what sequence does Theory of Mind usually start to develop?
Soon after birth, babies start to copy their 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. Some researchers think that the foundations for Theory of Mind are:
- Joint attention, itself built on early-developing skills like shifting gaze between people and objects, showing, following gaze, following points, and pointing;
- Imitation; and
- Play. Activities like pretend play and story-acting play a role in helping children develop Theory of Mind.
The typical sequence of development, using the wonderfully Plain English Hanen terminology, is:
- Wanting/liking: Learning that other people want and like different things. This leads to an understanding that people have feelings and do things when they get (or don’t get) what they want, and that you can change how people feel by giving them or saying what they want.
- Thinking: People think different things. People will do or feel things based on what they think. You can change what or how people think.
- Seeing leads to knowing: People don’t always see what you see. People will do or say things based on what they see. You can help people see the same things by giving them extra information.
- Hidden feelings: People don’t always mean what they say. What to do when people hide their feelings (e.g. joke, tease, lie). Learning how to hide your feelings.
- False beliefs: People believe what they think is true. People do/think things based on what they think is true. You can make people believe things that are true or not true.
3. Some important Theory of Mind milestones
The typical developmental milestones are as follows:
- Joint attention and imitation: before 12 months of age.
- Wanting and Thinking (First Order ToM): between 4-5 years of age, children develop the ability to think about what someone else is thinking or feeling.
- Seeing leads to knowing (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.
- Hidden feelings and false beliefs (Higher Order ToM): between around 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. Some people have Theory of Mind Gaps
ToM gaps are most associated with young children and with people with autism spectrum disorder (ASD). But other people have ToM gaps, too e.g. some people with:
- social language disorders;
- traumatic brain injuries;
- Parkinson’s Disease;
- behaviour problems; and
- mental illnesses.
5. How is Theory of Mind assessed?
There are a few formal assessments, such as the Theory of Mind-Inventory 2. But assessments of Theory of Mind usually involve detailed observations of the person and caregivers.
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 it 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.
6. How can you help your child to develop their Theory of Mind ? Free everyday and play tips and book resources
(a) Every day activities/play
- Wanting/Liking: going shopping, buying lollies and ice creams, packing for a holiday, dressing up different dolls/action figures, going to the library to choose different books. Choosing things to eat at dinner time. Playing with “mixed up jigsaws” (two puzzles with the pieces mixed up). Cooking or baking a cake. Choosing presents for family members from a department store catalogue (e.g. What does Dad like?).
- Thinking: Superheroes/villains, princesses/witches, astronauts/aliens, pirates/soldiers, e.g. “Where do you think we should go?”. When characters “fight” – “What could we do?”. “I Spy With My Little Eye!” Follow my eyes – “What am I thinking about?”. Early categories: “I’m thinking of something that drives on the road. What am I thinking about?”, “I’m thinking of an animal that is big and has a trunk. What animal am I thinking about?”
- Seeing leads to knowing: Hide and search for objects, e.g. “You’re getting warmer!” (closer to the object). Talking about what happened somewhere else, e.g. school. Getting your child to teach you something they know how to do and you don’t, e.g. how to search for a video on YouTube or play Minecraft. Describing what you can see when apart, e.g. with phones or (even better) Walkie Talkies! Playing “Guess Who?”, “I Spy” or “Headbandz”.
- Hidden feelings and false beliefs: Imaginative play. Help characters play “tricks” on each other. Have your hero feel scared, but act anyway. Learning to lose games and be a good sport. Have a joke of the day (get one of those terrible Jumbo books of Jokes). Talk out loud about your mistakes. Plan a surprise birthday party.
(b) Books to read together
The Hanen Centre has published a terrific list of books you can read with your children to help them to learn Theory of Mind skills. To help families (especially those without ready access to a public library), we have tracked down YouTube links for most of the books.
We’ve found that some of our clients with ASD, for example, prefer to watch the book being read on a screen. However, we recommend using the books as a way of having a conversation with your child, using some of the techniques we’ve summarised here.
|Book name and author||Theory of Mind Skill||YouTube Link|
|Red and Blue, I Like You – Sarah Albee||Understanding wanting/liking||https://youtu.be/mUb8X5Atj5c|
|Mortimer – Robert Munsch||Understanding wanting/liking||https://youtu.be/NNsGLAm46Go|
|It’s a George Thing – David Bedford||Understanding wanting/liking||https://youtu.be/TKtIshl_jRQ|
|It’s Not Easy Being A Bunny – Marilyn Sadler||Understanding wanting/liking||https://youtu.be/TKqI5pMjorw|
|Green Eggs and Ham – Dr. Seuss||Understanding wanting/liking||https://youtu.be/TJFRUz-8A1A|
|Little Pea – Amy Krouse Rosenthal||Understanding wanting/liking||https://youtu.be/aDBBBuZL7no|
|Big Sarah’s Little Boots – Paulette Bourgeois||Understanding wanting/liking||https://youtu.be/TjRVoAVLWVk|
|Handa’s Surprise – Eileen Browne||Understanding wanting/liking|
Understanding seeing leads to knowing
|George and Martha – James Marshall||Understanding wanting/liking||https://youtu.be/_qM2DdWm4k0|
|That’s Not My…. – Fiona Watt and Rachel Wells||Understanding wanting/liking||…Lion: https://youtu.be/ImOaKklxQzk|
|Yummy Yucky – Leslie Patricelli||Understanding wanting/liking||https://youtu.be/pFXAsVReaE8|
|Just Shopping with Mom – Mercer Mayer||Understanding wanting/liking||https://youtu.be/3aEu8ck-4uk|
|Dog Blue – Polly Dunbar||Understanding wanting/liking||https://youtu.be/XUEKClegkYU|
|Pinkalicous – Victoria and Elizabeth Kann||Understanding wanting/liking||https://youtu.be/pGy4PdAMYpM|
|Red Is Best – Kathy Stinson||Understanding wanting/liking||https://youtu.be/BO9pm4_NrdI|
|My Friend Is Sad – Mo Willems||Understanding wanting/liking||https://youtu.be/0QcfVOcTUL4|
|Don’t Let The Pigeon Stay Up Late – Mo Willems (and others in the pigeon series)||Understanding wanting/liking||https://youtu.be/1Uh4LVYvRLc|
|Are You Ready To Play Outside? – Mo Willems||Understanding wanting/liking||https://youtu.be/2_7dsm3j-nE|
|Just Me In The Tub – Gina and Mercer Mayer||Understanding wanting/liking||https://youtu.be/NIPlk1lSCpk|
|Snack Time for Confetti – Kali Stileman||Understanding wanting/liking|
|Duck and Goose – Tad Hills||Understanding thinking||https://youtu.be/mLTTZHL6wlM|
|If I Were You – Richard Hamilton||Understanding thinking||https://youtu.be/ujieMNpZ-rk|
|Blind Men and the Elephant – Karen Backstein||Understanding thinking||https://youtu.be/O9l1uiaxoGI|
|Runaway Teddy Bear – Ginnie Hofman||Understanding thinking|
|Elephant and Piggie books – Mo Willems||Understanding thinking||We are in a book: |
Should I share my ice cream?
See others above
|There’s A Sea In My Bedroom – Margaret Wild||Understanding thinking||https://youtu.be/WUrqjX_y2gc|
|One Frog Too Many – Mercer Mayer||Understanding thinking||Wordless book|
https://youtu.be/rB9m_PkfB-E (narrated and improvised by a child)
|It Looked Like Spilt Milk – Charles G. Shaw||Understanding thinking||https://youtu.be/qH3kxps0bJ0|
|Olivia – Ian Falconer||Understanding thinking||https://youtu.be/fWNXmelCpjQ|
|I Just Forgot – Mercer Mayer||Understanding thinking||https://youtu.be/vtiJXg–D6M|
|The Monster At The End Of This Book – Jon Stone||Understanding thinking||https://youtu.be/QvbXgAbU4gI|
|Pig Picnic – Patricia Hubbell||Understanding thinking|
Understanding hidden feelings and false beliefs
|A Monster Wrote Me A Letter – Nick Bland||Understanding thinking|
Understanding hidden feelings and false beliefs
|Little Quack’s Hide and Seek – Lauren Thompson||Understanding seeing leads to knowing||https://youtu.be/fR43uWaRiPs|
|What the Ladybird Heard – Julia Donaldson||Understanding seeing leads to knowing||https://youtu.be/Eu9mPX7DuLA|
|The Bear Snores On – Karma Wilson||Understanding seeing leads to knowing||https://youtu.be/pCkRtyXq-fg|
|The Gruffalo’s Child – Julia Donaldson||Understanding seeing leads to knowing||https://youtu.be/_JI1r5O-lH0|
|Seven Blind Mice – Ed Young||Understanding seeing leads to knowing||https://youtu.be/sta9xdOvSBU|
|Cheeky Monkey – Curtis Jobling||Understanding seeing leads to knowing|
|The Artist Who Stole Bits of the World – Bo Zaunders||Understanding seeing leads to knowing|
|Where the Wild Things Are – Maurice Sendak||Understanding seeing leads to knowing||https://youtu.be/Nn5Sl7zbQMI|
|Can You See What I See? (series) – Walter Wick||Understanding seeing leads to knowing||https://youtu.be/tcaDVWRn8U0|
|Rosie’s Walk – Pat Hutchins||Understanding seeing leads to knowing||https://youtu.be/DjC2Db40dXA|
|Look Look Look – Tana Hoban||Understanding seeing leads to knowing|
|Goodnight Gorilla – Peggy Rathmann||Understanding seeing leads to knowing|
Understanding hidden feelings and false beliefs
|Pizza Pat – Rita Golden Gelman||Understanding seeing leads to knowing||https://youtu.be/uYXRygplFsY|
|My Truck Is Stuck – Kevin Lewis and Daniel Kirk||Understanding seeing leads to knowing||https://youtu.be/ZrNROE3-1kQ|
|Suddenly – Colin McNaughton||Understanding seeing leads to knowing||https://youtu.be/zJIZ2sAeVhE|
|Little Red Riding Hood||Understanding hidden feelings and false beliefs||https://youtu.be/Xcy1P_YuhcQ|
|Goldilocks and the Three Bears||Understanding hidden feelings and false beliefs||https://youtu.be/AOXqZw9kj-I|
|My Lucky Day – Keiko Kasza||Understanding hidden feelings and false beliefs||https://youtu.be/CtoDBe1Jhwo|
|Are You My Mother – P.D. Eastman||Understanding hidden feelings and false beliefs||https://youtu.be/WH_SK0Jvq8M|
|The Pigeon books – Mo Willems||Understanding hidden feelings and false beliefs||The Pigeon wants a Puppy: https://youtu.be/LHgxiJtQe3g|
The Duckling gets a Cookie:
|The Gruffalo – Julia Donaldson||Understanding hidden feelings and false beliefs||https://youtu.be/ZsAY3Xj5ir8|
|Love Splat – Rob Scotton||Understanding hidden feelings and false beliefs||https://youtu.be/b-FpHBiwuHg|
|The Patterson Puppies (series) – Leslie Patricelli||Understanding hidden feelings and false beliefs|
|A Lion In The Meado – Margaret Mahy||Understanding hidden feelings and false beliefs||https://youtu.be/PffrDNoHKos|
|Pete the Cat and his Four Groovy Buttons – Eric Litwin||Understanding hidden feelings and false beliefs||https://youtu.be/ljf3rZXe4IY|
|The Frances Books (series) – Russell and Lillian Hoban||Understanding hidden feelings and false beliefs||Bread and Jam for Frances: https://youtu.be/KZhCqQNoopE|
A Bargain for Frances: https://youtu.be/dYKnchZm0is
|Moo Hoo – Candace Ryan||Understanding hidden feelings and false beliefs||https://youtu.be/RurLoHKO7tg|
|Henny Penny – Paul Galdrone||Understanding hidden feelings and false beliefs||https://youtu.be/5gAL7f1Qjjk|
|Very Lonely Firefly – Eric Carle||Understanding hidden feelings and false beliefs||https://youtu.be/_XrPyF4Mpl4|
|Mmm….Cookies – Robert Munsch||Understanding hidden feelings and false beliefs||https://youtu.be/sQFKXuSjg6A|
|Scaredy Squirrel – Melanie Watt||Understanding hidden feelings and false beliefs||https://youtu.be/cC4LDGxtpmw|
|Duck Soup – Jackie Urbanovic||Understanding hidden feelings and false beliefs||https://youtu.be/Bi5pwAiS1XA|
|Sir Charlie Stinky Socks (series) – Christina Stephenson||Understanding hidden feelings and false beliefs||Sir Charlie Stinky Socks and the Really Big Adventure:|
|Olive The Other Reindeer – J. Otto Seibold and Vivian Walsh||Understanding hidden feelings and false beliefs||https://youtu.be/9_r68U4D9N0|
For all of the books in one handy list, check out our Books to develop Theory of Mind Skills YouTube Playlist.
- Wanting and Thinking (First Order ToM): The main therapy goal is to help the child recognise others’ 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 those listed above.
- Seeing leads to Knowing. Hidden Feelings, False Beliefs (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.
7. Clinical Bottom line
Theory of Mind is not a simple or single idea. ToM gaps are common for people with ASD. But they affect others too, and can cause big social problems. We hope that parents find some of the ideas and resources listed in this article useful for helping their children to improve their understanding of others.
- “Why should I let my late-talker play with other kids?” Because play promotes learning: here’s why and how
- Parents: teach categories to your kids to ignite language development
- Reading with – not to – your pre-schoolers: how to do it better (and why)
- Books to develop Theory of Mind skills YouTube Playlist
Westby, C. & Robinson, L. (2014). A Developmental Perspective for Promoting Theory of Mind. Topics in Language Disorders, 34(4), 362-382.
Hanen e-Seminar: Teaching Tuning In: Practical Strategies to Promote Theory of Mind for Verbal Children on the Autism Spectrum, Tamara Stein, The Hanen Centre.
Special thanks: We would like to thank our superstar administrative assistant and student speech pathologist, Cherie Finocchiaro for tracking down the YouTube links to each of the books listed in Part 6 of this article.
Kids are rarely diagnosed with autism spectrum disorder (“ASD“) before three years of age. But the research tells us that the best time to start intervention is between 18 months and 4 years of age.
We know that young kids with ASD often have deficits in social communication skills. These include deficits with:
- joint attention: the shared focus of the child and another (e.g. a parent) on an object (e.g. a ball or truck);
- shared affect: the social use of emotional expressions in response to others (e.g. smiling);
- eye contact;
- gestures; and
- functional and symbolic play.
We also know that speech and language development alone can’t be used to differentiate children with ASD from children with developmental disabilities or language delays because speech and language delays are common to all developmental delays.
Wetherby (2007) identifies 5 core deficits that are “red flags” or warning signs of possible ASD in early years:
- no or limited gaze shifting (looking from a person to an object or other person and back to the first person);
- not looking at where someone is pointing;
- limited or no joint attention;
- slow rate of communication (typically developing 12 month olds communicate about 2.5 times a minute, increasing to about 7.5 times a minute by 24 months of age); and
- few early gestures (e.g. pointing, “feeding” self from an empty spoon; hands to mouth to indicate wanting to eat).
In 2001, Robins and colleagues identified 6 red flags for ASD in children aged between 18 and 30 months of age, namely:
- limited interest in other children;
- limited pointing for interest;
- limited imitation of a parent or other caregiver;
- limited showing of objects to indicate interest;
- limited response to their name; and
- not looking at where someone else is pointing.
In 2012, Vaness and colleagues published a study looking at three groups of Australian children – typically developing, language-impaired and children with ASD. They found that:
- reduced use of early gestures at both 12 and 24 months most clearly differentiated children with ASD from comparison groups, although they were unable to identify specific gestures distinguishing kids with ASD from others. Instead, the difference appeared to be in the pattern of early gestures used as a whole;
- responding to name, waving, pointing and giving gestures, requesting attention and help, and sharing an interest did not safely discriminate kids with ASD from typically developing children at 12 or 24 months;
- joint attention at 12 months, and gaze-point following and the showing gesture at 24 months, may discriminate between children with ASD and children with a pure language impairment or delay; and
- parents of children with ASD are likely to be aware of the slowing development of their child during the second year.
What do these red flags look like in the real world?
Some of the potential warning signs listed above can be hard to visualise – especially if you haven’t met many children with ASD. Autism Speaks, one of the world’s leading ASD research and advocacy groups, hosts a fantastic video glossary resource, including several valuable video examples of red flags for ASD. To access the videos, you first have to register (it’s free). But it’s well worth the effort – especially if you want to see some great video examples directly comparing behaviours of children with ASD to those of typically developing children.
You can access the video glossary here.
Trust your instincts. If you are concerned that your toddler is not developing typically and might be displaying some of the red flags for ASD, consult with your child’s pediatrician. But don’t panic. “Red flags” like the ones listed here – though useful – are just early warning signs of possible ASD. Only a paediatrician can diagnose your child with ASD, and only then after a thorough assessment, usually including input from speech pathologists, psychologists and other health professionals.
Principal source: Vaness, C., Prior, M., Bavin, E., Eadie,P., Cini, E. & Reilly, S. (2012). Early indicators of autism spectrum disorders at 12 and 24 months of age: prospective, longitudinal comparative study. Autism, 16(2), 163-177.
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).