Autism: A Specific Cognitive Disorder of 'Mind-Blindness’
Simon Baron-Cohen
Reviewer's Introduction
This is a brief summary of a paper by Simon Baron-Cohen from 1990. In this paper he discusses his theory of autism as being a specific cognitive disorder, specially arising from the absence of a 'module' called ToMM, or "Theory of Mind Module". This putative module in the brain is responsible for reading the minds of others; how they are feeling, what their intentions are, what their desires are, what they might believe, and so on. Without it we can't function in the social world.
I have only just come across this specific theory of autism, which explains why I am reviewing a paper from 1990. I will soon be reviewing Simon Baron-Cohen's book on this subject, Mindblindness : an essay on autism and theory of mind, 1995.
Simon Baron-Cohen is a Professor of Psychology at the University Of Cambridge. [1] He is head of the Autism Research Centre there.
Notes from the Paper
Simon Baron-Cohen accepts that it is possible to map cognitive functions to areas of the brain. However, the focus in this paper is on cognition. Specially the proposed deficit in social cognition in autism.
Reviewing the history of the disorder, (that is the creation of the concept of autism), Baron-Cohen reports that autism was first described in 1943. It was initially seen as an emotional disorder and inked by psychoanalysts to the mother-infant relationship. (I wonder if this does not explain the fairly frequent leaning into the idea of the supreme importance of the mother-infant interaction in theory of Intensive Interaction). [2] The next development was to see autism as a language development disorder, before it was understood that that alone could not account for the social "abnormalities" of autism. From 1970 a view of autism as a cognitive problem was developed. Baron-Cohen is clear that autism is not a problem in perceptual systems, as some modern theorists argue [3] though sensory "handicaps" can occur in association with autism. There is a strong correlation between autism and learning difficulties; the ability to make "conceptual distinctions" for people with autism is related to the extent of any learning difficulties. However; autism involves specific problems with "meaning" and information processing. One study has shown that young people with autism score better than non-autistics on a task locating images hidden as patterns inside another image.
Theory of Mind
This term was first proposed in 1975. It is called a theory because it relates to a supposed function which imputes, but does not observe, states in others, and because it is the basis for making predictions about the world.
Baron-Cohen gives this example:
A man comes out of a shop and walks off down the street. About half-way down the street he suddenly stops, turns around, runs back to the shop, and goes inside. (We instantly think to ourselves that the man must have remembered he has left something in the shop, that he wants to retrieve it, and that he believes it will still be in the shop). The man then re-emerges from the shop, but this time he walks along slowly, scanning the ground. (Now we make the assumption that whatever he thought was in the shop wasn’t there, and that he now believes he may have dropped it on the pavement outside). If we lacked the ability to refer to the man’s beliefs, desires, etc., his actions would seem most peculiar.
The "theory of mind" ability gives one an ability to understand social behaviour. Without it one would find the social world confusing and even frightening and one withdraw. Furthermore; not seeing or building models for how other people might be feeling or what their desires etc. might be, we might treat them as objects. These behaviours are observed in people with autism, lending support to the theory. A related theory is that the ability to develop a model of the intentions and, in general, what is going on in the mind of the other, is an essential part of communication. Without this ability communication, even if both parties are verbal, can be difficult. So, a deficit in theory of mind ability can, potentially, explain both the social and communication difficulties which are characteristic of autism.
Baron-Cohen describes an experiment to test for the ability to consider belief and make predictions. There are two researchers at a table and one child. Researcher A puts a marble in a basket. Researcher A then leaves the room. Researcher B now transfers the marble to a box. The child observes all this. Researcher A now re-enters the room. Where will she look for the marble? Of groups of normal children and children with Learning Difficulties (Downs Syndrome) 87% or 86% chose the basket (correct answer; this is where Researcher A thinks she left it), But just 20% of autistic subjects. Because the comparison was made with people with LD of similar (in fact) lower chronological and mental age than the autistic group it can further be said that the finding cannot be explained by developmental delay. A further check ruled out memory as the issue for the autistic children. By 1990, the time this paper was written, the same basic experiment had been repeated 12 times.
The above experiment focussed on belief. Some of the other 12 studies tested, know, think and pretend. Similar experiments have been done with deaf people, language impairment and unspecified mental handicap and have not produced the same results, supporting the view that the finding is specific to autism.
Additional evidence comes in the form that, in contrast to normal children, autistic children rarely use words connected with thinking, knowing or believing in speech. In order to further isolate the finding experiments have been done to ascertain with autistic children are deficient in other cognitive domains. Experiments have found them not to be impaired in a number of areas such as peer recognition, person permanence and so on. Autistic children are also able to judge what another person can see, "perceptual role-taking". However; there are areas in which autistic people are also found to have cognitive deficits. These include response to emotional stimuli and imitation skills. These findings indicate further research pathways.
A direct link to a part of the brain related to theory of mind is assumed. It is noted that development of theory of mind is common to all normal children in all cultures. In terms of the link between a proposed deficit in theory of mind and behaviour the link is, as mentioned above, proposed to be that a lack of ability to understand intentions and beliefs of the other makes social interaction and communication difficult because the social context is missing.
Baron-Cohen describes an interaction with a 13 year old autistic boy. The boy asked him a set of standard questions, which he asked all other visitors to the school. He allowed time for Baron-Cohen to answer. But Baron-Cohen argues that these questions showed that the boy, Martin, was not thinking about what Baron-Cohen might know, or not, about these subjects, whether he might be interested in them or not, in short, that because he could not infer what Baron-Cohen was thinking and might, or might not know, he was unable to have a more flowing conversation. This is because reading or inferring knowledge, intentions and beliefs is a part of communication, as it is a part of social interaction.
To further strengthen the case for the theory, of a "theory of mind" and its deficit as being the cause of autism it is necessary to correlate scores on a test for "theory of mind" with scores on communication and social tests. Such work was underway when this paper was written.
However; the direct correlation is not established. 30% of children with autism with a mental age of 4 do not show a lack of theory of mind. Even these children though may have problems with second order belief. (John thinks that Mary thinks that the marble is in the basket). Second level order belief is usually a capacity of 7 year olds. Thus these children while they have some theory of mind capacity are delayed in their development. Tests have shown that no autistic children under 11 can pass the second order test. But some older children can. A longitudinal study was being conducted at the time of writing of this paper, presumably to try to investigate the developmental questions.
What developmental stages pre-date development of theory of mind and which might be deficient in autistic children? Baron-Cohen suggests that a likely precursor is the ability to understand another person's attentive states; what they find of interest. Autistic children can be observed to have impairments in the field of joint-attention behaviours, especially in the area of declarative pointing, (pointing at an object to express interest).
In conclusion the author asks whether, with this theory in mind, it might be possible to devise tailored training programmes to help people with a deficit in "theory of mind". [I will follow up this work and report on it in a subsequent post]
Reviewer's Conclusion
It is not 100% clear to this reviewer exactly what the view is of development delay of theory of mind. Is the suggestion that the "disorder" as a whole should be interpreted as a developmental disorder; in which case all people with the disorder, should develop some capacity, or is it proposed that in only some people is there a capacity for development? I do not know enough about how developmental disorders are generally construed but one can imagine a theory in which in all cases the deficit (lack of theory of mind) is seen as a developmental disorder but, realistically, noticeable development is only likely in a proportion of people. The fact that no autistic child under 11 can pass the second order belief test, but some over 11 year olds can, seems to suggest that theory of mind can be considered a developmental disorder. The author also raises a question about possible "degrees of mind blindness (deficit in theory of mind)". I think this is separate from the developmental question.
This is a really great paper. It is very clearly expressed. The author demonstrates that he does not suffer from a theory of mind deficit in that he manages to achieve what all good writers should achieve; writing in such a way that does not assume pre-existing knowledge on the part of the reader. That is; he shows that in his communication he is thinking about what is available and what is going on in the mind of the reader. (Which, incidentally, supports the idea that the ability to read or infer the intentions and beliefs of others is important not only for social interaction, but also for communication, as the author proposes). The author is also rigorous in outlining the experiments necessary to eliminate alternative explanations and establish the veracity of the theory of theory of mind, (a developmentally related deficit in), as being the main factor in autism.
I will follow up this author with his 1995 book and other papers in the coming months.
Simon Baron-Cohen (1990) Autism: A Specific Cognitive Disorder of & 'Mind-Blindness’, International Review of Psychiatry, 2:1, 81-90, DOI:10.3109/09540269009028274
* I bought my copy from Taylor and Francis online.
Notes.
1. https://www.psychol.cam.ac.uk/people/simon-baron-cohen
2. https://substack.com/home/post/p-153858723
3. Phoebe Caldwell expresses the sensory view of autism. One of the authors of Intensive Interaction. Theoretical Perspectives. Ed. Dave Hewett ibid [2] does. Chapter 4.
[Image credit: https://commons.wikimedia.org/wiki/File:Bulle_dessin%C3%A9e_%C3%A0_la_craie.jpg]
