Paying too Much Attention to Theory of Mind

I’ve been thinking about how to discuss autism in a way that is more than just a list of symptoms.   I would like a description that includes the seriousness of the disability but with terms that don’t indicate that having autism is a static unchanging condition.

It is common to read that people with autism have an impaired theory of mind.   Rachel Cohen-Rottenberg has an interesting take on this.  So does Patricia Harkins.

In the book Adapting Minds by David Butler, the author says that Simon Baron Cohen has argued that autism is evidence for a theory of mind module.    The author goes on to explain why he thinks this idea is incorrect.   He makes a lot of good points.

The main point of the author’s book seems to be to discredit evolutionary psychology, and he has an issue with the idea of modularity (as it relates to the brain) in general.   (Here’s an interesting evolutionary psychology primer.  The blog author was nice enough to answer my question in the comments.)

David Butler writes:
An essential characteristic of modules is that they function independently of one another.  Consequently if a module is impaired or malfunctioning, highly specific forms of cognitive or behavioral deficit should result.  These deficits should be confined to the domain of the module and should not affect cognitive or behavioral performance in other domains. 

David Butler takes issue with the false-belief test that is usually used to prove a lack of ToM.  He writes:

Rather than simply being an inability to understand the minds of others, autism appears instead to prevent individuals from being able to damp down the total array of irrelevant inputs to the brain.  

Thus, while autism does involve an inability to pass false-belief tests, it encompasses a wide-ranging array of cognitive and affective deficits relevant to understanding others.   The strongest confirmation of the theory of mind module hypothesis would come from a deficit that disrupted theory of mind but left all other abilities in tact.

If a theory of mind were acquired from some more general learning disabilities, rather than being embedded in a module, it would not be surprising that autistic children fail to acquire a theory of mind given their avoidance of interaction with other people and their inability to attend to complex and changing environmental stimuli. 

Here is a link by others that seem to have the same opinion.  And another.

I think part of what bothers me about the idea of defining autism as a lack of aToM module is that it seems to imply that the brain is static, and that ToM is either on or off.     The term mind blindness or context blindness is very similar.  Why can’t we call it context nearsightedness or mind farsightedness?  I realize that autism is a serious condition and that many individuals have significant disabilities.  But why should we use terms and phrases that are inherently negative and not completely accurate?

I wonder if it would be more accurate to talk about joint attention instead of ToM.  That is really closer to the root of the issues, and does not involve the idea of a self contained module in the brain.

In a review appearing in the October issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, University of Miami psychologists Peter Mundy and Lisa Newell summarize recent findings supporting a theory of joint attention dubbed the “attention-systems model.”
This model proposes that human social cognition is really the extraordinary result of two basic forms of attention. One type of attention, regulated by a specific set of neurons in the brain, involves paying attention to the external world and the actions of people. The second type involves paying attention to the self and is regulated by a different network of neurons.
Mundy and Newell propose that the key to human joint attention is that these two areas of the brain become interconnected throughout development and interact so we can simultaneously keep track of the direction of self and other’s attention. Interestingly, communication between brain regions, especially those implicated in initiating joint attention, is one of the main cognitive impairments of autism.

It seems to me that it is accurate to say that autism involves a deficit in processing information that leads to delays in joint attention,and the delays in joint attention lead to the symptoms we commonly associate with autism.

A description like this implies significant disability is possible.  But instead of describing autism as a lack of humanity, it seems to describe how what we call autism really is a natural part of the human condition.   It also offers a root cause (a deficit in processing), and the idea of developmental progression.  So contained within the description are ways to help an individual with autism.

Reference: Adapting Minds, David Butler, (The MIT Press, 2006) pages 191 – 193

Special thanks to L. for talking me through this and suggesting the perfect reading material.

Reading some autism fiction this time

Mockingbird – Katherine Erksine

This book is actually a young adult book.  One of E.’s friends is now working at our local library.  It’s like having my own personal librarian, and he suggested this book.

This story is told from the point of view of Caitlin, a ten year old girl with Aspergers Syndrome.   She’s in the fifth grade, in a fully included class.  Her brother was recently killed in a school shooting at the town’s middle school.  She lives with her widowed father.  The tragedy plays a big part in the story.   Caitlin’s brother was an important mentor for her, teaching her many things about how to interact with the world.  The book is about how Caitlin learns to deal with the loss of her brother and learn about emotions in the process.

The author does a great job of describing how Caitlin interprets the world.  The book starts with her remembering what she calls YOUR MANNERS, and getting a sticker on her chart towards the opportunity to watch a video.   It is clear she doesn’t understand the reason for saying thank you or whatever, she has just memorized the correct responses and has a desire to please to obtain her reward.

Caitlin gets pulled out of class to have time with what I assume is a Special Ed Teacher or inclusion specialist.  This teacher suggests that Caitlin take recess with the younger kids.   She ends up befriending a first grader, and he helps her to understand that YOUR MANNERS are actually her manners.  She uses the phrase MY MANNERS.  It was really interesting reading about her coming to understand this, and developing a friendship with the younger boy.   I’m not sure how realistic the depiction of her peers coming to treat her better is, but it was heartwarming.

I’m a total wimp when it comes to fiction that is sad, so this obviously colors my opinion.  I thought that the background of the tragedy almost took away from the message of the book.   Does a young person with Aspergers Syndrome have to experience such an tremendous loss to be able to develop a better understanding of emotions?   I do get that books about school shootings have a place, I just think I would have preferred the topics be dealt with separately.

Be sure to have a box of Kleenex handy if you read this.

Reading material- Art as an EI Tool for Children with Autism

Thanks to the library, I recently read the book  Art as an Early Intervention Tool for Children with Autism by Nicole Martin.   Ms. Martin has a younger brother with autism.  She was trained by a behaviorist as a young adult to work with her brother.  As an adult she is an art therapist working with people on the spectrum.

The first chapter describes autism.   If you are like me and have read tons of autism books, this chapter seems unnecessary.  She does offer good descriptions of scripting (echolalia), perseverating and stimming.   I think my favorite part from this chapter is:  Children with autism hear “no” a lot from adults; helping them find ways to express and develop their talents lets them say “yes” to themselves.

She discusses how humans seem to have a natural tendency towards making art, and reasons that there is no reason to think that people with autism would be any more or less interested in art making then their typical peers.   She also mentions that symptoms of autism such as hyper focus or tactile defensiveness, can make it appear that the individual on the spectrum is not interested.

Ms. Martin outlines what she calls basic assumptions that  she writes need to be understood before using art as an intervention tool.

The adult is not “fixing” a child’s artwork, but using art to “fix” parts of the child that can be best engaged using art

The art itself (the product) is not as important as gaining the self-discovery, experimentation, tactile tolerance and so on (the process) that is required to make it.

Skills such as imagination and creativity are worth rehabilitating in children with autism.

You must believe that creativity can be learned.

The author describes “good scribbling” (focused, contemplative, experimental, sometimes even chaotic) and “bad scribbling” (symptomatic). She provides some really useful illustrations and easy to understand descriptions of children’s art development using the theories of Victor Lowenfeld and Rhoda Kellogg.

The author gives a number of good tips to help a child with autism move beyond scribbling.  She suggests reinforcing any scribbling or attempts at art work, but to give extra praise and reinforcement to attempt that are the best, or exhibit experimentation and variety.

Visual supports are also another tip- drawing a circle or line on the page can help jumpstart a drawing.  When a child puts art tools in their mouth she suggests offering an appropriate chew item. (I can attest that this works).

She also suggests that the parent (or therapist) make art along with the child.  She offers the idea of copying what the child is doing.  I found it really useful that she says the parent should attempt to draw at the child’s level, and to model appropriate scribbling and early drawing.  She mentions that a higher skill level can fascinate and frustrate a child with autism.  This reminds me of what John Holt wrote in How Children Learn, about how children lost interest in activities in which he clearly knew more then they did.

Ms. Martin lists nine autism symptoms and the corresponding artwork characteristics.  It is an interesting way to look at it.  One of the symptoms is sensory issues and the characteristics are – use of materials for self stimulation, tactile defensiveness and art material’s impact on regulation.

She also lists six major goals for children on the spectrum that can be best addressed using art.   One of them is sensory regulation and integration.  She writes Some children on the spectrum get “stuck” in the kinesthetic feeling of using art materials and are slow to move into representational work.    Her suggestions are to become aware of a child’s reactions to different textures and to take control of art activities.  She also suggests activities that create artwork using the entire body like tracing and masks.  I would have liked to read more details about how to work with this.

The author details what she calls tools of the trade, describing paints and other art materials.  And she also gives tips for providing the optimal environment for creating art, what she calls a quality art experience.  She writes An individualized directive with least invasive prompt possible is my personal rule of thumb when working with a child with ASD.  She gives a very good and detailed description of prompt hierarchy, and shows her knowlege of ABA with suggestions for problem behaviors and reinforcements.

Reference: Art as An Early Intervention Tool for Children with Autism by Nicole Martin, (Jessica Kingsley Publishers, 2009) Pages 25, 30, 31, 41, 59, 73, 113

Looking for answers

I’ve been looking for a book that goes into detail about child development.   When R. had EI, the therapists spent a long time trying to get her to match pictures in a laminated version of the book Brown Bear Brown Bear.   She was never interested.   They tried several different books.  Finally they changed to a 3D matching program using toys and she was interested and did well, moving quickly on to sorting.  I asked why this was easier and they told me that 3D matching is an ability developed before 2D matching.  I won’t get into my frustration over the wasted time.  I would however like to find some resource that explains why one ability comes before another and how it is supposed to typically develop.

In February, when she had her assessment with the school department she could not (or in some cases would not) stack 6 blocks, do an insert puzzle, arrange rings in order on a post, or string beads.  Now she can do all of these tasks, and enjoys doing some of them on her own, not just for a reinforcer.   I wonder why are certain tasks part of an assessment, and what does mastery of each of them mean in terms of development?  It seems to me that after she learned to match and play with some toys appropriately her receptive language improved.  Is that a coincidence, or are they related?

I recently read the book How Children Learn by John Holt.  It is an older book and not specifically about children with special needs.  It did not actually answer my questions, but I do feel like I learned from reading it.  I’m going to use this blog to store my notes about some of the reading I’m doing.

The main point that the author illustrates throughout the book is that children learn best when they are inspired and having fun, not when actually being taught something in a structured way.   Mr. Holt writes How much people learn at any moment depends on how they feel at that moment about the task and their ability to do the task.

He does mention children with autism in one section and it is worth quoting.  ...much has been said and written about autistic children, children who seem to have withdrawn into a private world of their own, who don’t have or want any contact with the outside world at all.  Arguments rage about how best to treat them.  The conventional wisdom still seems to be that for severely autistic children not much can be done; they can perhaps be trained to take physical care of themselves and meet minimal social requirements, but not much else.  But there have been some astonishing “cures.”  Barry Kaufman in his book Son Rise, describes one that he and his wife effected with their apparently hopeless autistic little boy.  The point I want to make here is that they began their cure, and first began to establish some faint communication with their terribly withdrawn child, by making a point, for hours at a time if need be, of imitating everything that he did.  This was the door or path by which they led him or persuaded him to come back into the everyday world.

No one can ever know exactly why this cure worked.  But it feels right to me.  If I felt that the world was so unpredictable and threatening and myself so powerless that I could not risk myself in that world, but had to make a tiny, safe private world of my own, that outside world might begin to seem less unpredictable and threatening and myself more powerful if I could make things happen in it.

All children want and strive for increased mastery and control of the world around them, and all are to some degree humiliated, threatened and frightened by finding out (as they do all the time) that they don’t have it.  Perhaps autistic children need this control more and are far more frightened by not having it, and so, unlike most children, are not able to struggle patiently until they are able to get it, but instead, again unlike most children, must retreat from the big world around them into a private inner world of their own.

I think that repetitive behaviors, restricted interests and rituals can be seen as a symptom of this need for control in individuals with autism.  I also think  Mr. Holt would have liked Floortime.

The chapter on talking was interesting,  I like what he writes about infants learning to speak:

I now feel strongly that much of the time infants are not trying to imitate sounds at all, but are actually trying to speak, that is to use sounds to convey wishes, feelings and meanings.

R. has been babbling for years now.  The quality of the babbling has been evolving. Now it has all the sounds and intonations of sentences, there are sometimes words I can understand mixed in with babbling.   She will look right at me and babble with an expression that seems to say that she is waiting for a response.   I’ve thought for a long time that her babbling actually meant something to her.    Mr. Holt also writes about children learning to write who write what looks like nonsense but actually consider themselves to be writing meaningful letters or stories or whatever.  He wrote that when each of these children finally realized that no one could understand their writing they stopped and were quite upset about it.  They all did eventually end up learning to read and write properly.  I wonder how this applies to learning to speak and to a child with autism.  I think that R. realizes that we don’t understand her when she babbles.  When I do understand what she is saying she gets this expression of pure bliss at being understood.  It makes me feel bad that I don’t understand more and I wonder if this discourages her from speaking more frequently.

Mr. Holt does attempt to answer this question in regards to typically developing children:

I suspect that early infant talkers… mean to send messages with their voices, as the big people around them obviously do, and they think that these messages are being received. Suddenly, perhaps around the age of one and a half or two, it dawns on them that most of their messages are not being received at all, and that they really can’t talk like other people, but must go through a lot of trouble to learn how.  This may be one of the things that makes two year olds so touchy -they have just discovered that among all the things they don’t know how to do, they don’t know how to talk.  They are bursting with things to say, needs and feelings, and awarenesses but have no way to say them.

We assume that since words are the shortest and simplest elements of language that we learn them first. But it is far more likely that we learn words last.  First we learn the large idea of communication by speech, that all those noises that come out of people’s mouths mean something and can make things happen.  Then from the tones of people’s voices and the contexts in which they speak we get a very general idea of what they are saying,

Reference: How Children Learn by John Holt.  (Merloyd Lawrence, Delta/Seymour Lawrence New York 1982)  Pgs 43, 50, 81, 93