Brent, Ella; (1999) Do 'advanced' theory of mind tasks offer a useful measure of mentalising ability in children with autism who have verbal and intellectual abilities within the normal range? Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

The development of the 'theory of mind hypothesis' altered the autism research field by offering a single underlying cognitive impairment to account for the defining triad of impairments. Baron-Cohen, Leslie and Frith (1985) suggested that autism was the consequence of a deficit in the development of a theory of mind. This would mean that autistic children failed to develop an understanding that people have minds as well as bodies. Baron-Cohen et al. (1985) demonstrated that most autistic children, and typically developing children under the age of four years, were unable to state a story character's mistaken belief, unlike typically developing children over 4 years who were able to do so. The finding was particularly significant because the theory of mind impairment appeared to be specific to autism, and not explained by intellectual or language ability. False belief tasks developed to investigate autistic children's ability to form mental representations of people's thoughts, feelings and desires, used a pass/fail paradigm which was consistent with the view that theory of mind was an all or none affair. However, inconsistent performance by autistic children across a variety of false belief tasks, and the ability of some autistic children with good verbal ability to pass false belief tasks, challenged the model of an absence of any mentalising ability. Performance on false belief tasks at ceiling by many autistic children with a verbal age above 6 years has stimulated the development of more advanced tasks, scored on a performance scale to assess the extent of mentalising ability rather than its presence or absence. This study matched 20 autistic children between 6-12 years with typically developing children for chronological age, verbal age and IQ. The children's theory of mind ability was assessed on 'standard' false belief and a picture sequencing task, and on three 'advanced' measures: an adapted version of the Strange Stories (Happe, 1994; Happe, unpublished), a children's version of the Eyes task (Baron-Cohen et al., 1997; Baron- Cohen, unpublished) and a new Cartoons task (Happe, unpublished). The autistic group's scores were significantly lower than typically developing children's in accounting for story characters' actions on mentalising stories, but not physical stories. The autistic group used significantly less mental state language in their answers than the typically developing group, with a specific difference in the use of second order phrases. Performance of the two groups was also distinguished by the Eyes task, but not the Cartoons task. Overall, the 'advanced' theory of mind tasks were able to discriminate group membership with 85% accuracy. The use of alternative cognitive strategies to produce appropriate answers to lower level mentalising tasks in a more laborious way than the affective route used by typically developing children may explain these findings. In addition, it may be that these able autistic individuals experience an impairment in the ability to use low level mentalising abilities which they may in fact possess.

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