So, what is Theory of Mind? Theory of Mind is one of the main deficits in individuals on the Autistic Spectrum yet it is rarely known or understood by professionals who work with children with Autism. I know this because I ask them before they come to work with me. In order to work with a child with Autism you must understand what it means to not have Theory of Mind.

Most often parents of children with Autism do not know what Theory of Mind is either.

Why Is It Important?
It is important for them to know what this term means as it will give them a better understanding of why their children are having such difficulties. It also allows parents to predict situations that may be difficult for their children due to their absence of Theory of Mind.

Even the highest functioning children with Autism most often do not have Theory of Mind.

Theory of Mind is the ability to not only understand that people have different beliefs, motivations, knowledge and moods but also understand how that affects their actions and behavior.

What Studies Tell Us
Many experiments have been done over the years to demonstrate Theory of Mind. My favorite being the “Smarties test”. In this experiment typically developing children, and children with Autism were shown a closed container with a Smarties label on it. They were then asked “What do you think is in here?”

The children in both groups answered “Smarties”. They were then shown that the container contained pencils, not Smarties.

Then they were asked a couple of other questions. The first question being “When I first showed you this container, what did you think was in here?” The typically developing child answered “Smarties”.

The children were then asked “When the next child comes in what will he think is inside here?”

Again they responded with “Smarties”.

When these two questions were asked to children with Autism the majority answered pencils to both questions.

The findings of this experiment revealed that most children with Autism do not have the ability to understand other people’s different beliefs. Typically developing children will have this understanding at 3-4 years of age.

Another Core Deficit
Perspective taking while sometimes used interchangeably with Theory of Mind is also very important to understand when involved in the lives of children with Autism.

While Theory of Mind is a necessary component of perspective taking I do like to differentiate between the two.

Perspective taking refers to our ability to relate to others. It is our ability to perceive someone else’s thoughts, feelings, and motivations. In other words it refers to our ability to empathize with someone else and see things from their perspective.

Most people can intuitively tell how someone else feels in a conversation. When they speak to someone who’s looking around and not paying attention, they perceive the person is not interested in the conversation or is distracted for some reason. They know if they see tears in the person’s eyes that the person is upset.

Experience From A Social Skills Class
In my social skills classes I often do an activity in which the children decide what gifts would be appropriate or inappropriate for their peers, family members and other people in general. This activity shows clearly who has difficulty with Theory of Mind and Perspective Taking.

In a recent class of 5 children with one being on the Autistic Spectrum the deficit was clearly evident. I went around the table and asked each child what they would buy their parents, grandparents and even a baby for the holidays. The one little girl who was on the Autistic Spectrum answered a Barbie Doll for everyone.

It was clear that this was what she wanted for a holiday gift however she was unable to get inside anyone else’s thoughts and decide what might be a good gift for them. You can see how these deficits will significantly impact social functioning of these children.

It is very important to note that lack of Theory of Mind and Perspective Taking is not a sign of intelligence. One can be of gifted intelligence and not have Theory of Mind or Perspective Taking skills.

So What Can Be Done?
I am often asked if these deficits can be overcome and/or taught. The answer is both yes and no. With intervention some people with Autism will develop a basic level of Theory of Mind which helps them function better in the situation they are currently in. In other words we can teach skills that are situation dependent. If you read any of the writings of Temple Grandin she explains this in more detail.

Also when pretend play and joint attention* is addressed early on the deficits may be less severe later in life.

It is in the best interest of both parents and professionals who work and live with individuals with Autistic Spectrum Disorders to learn as much as you can on this topic. It will be very eye opening for you as it was for me when I first learned about it. Learning leads to understanding. Understanding leads to progress.

* Joint Attention refers to sharing the experience of observing an object or event via non-verbal communication such as pointing or following a gaze. For example if I look at something and you then look to see what I’m looking at without being verbally told to. This skill should be present in babies by the age of 12 months.

Note: If you are concerned about your child’s social development you should call 914.488.5282 to set up a confidential consultation.

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Have you ever been in a situation where everyone was different from you? If so you have some concept of what it must be like to have a social skills disorder. I’ve been in that situation many times, most of those times I have been by myself. While it is not the same as actually having a social skills disorder being in an environment that made me feel alone and like an outsider made acutely aware of how important having good social skills is. That’s why I spend so much time talking about this issue.

I can’t imagine where I would be if I had not been able to pick up on the unwritten social rules around me. I certainly would not be writing this to you today.
We all take these social rules for granted. We don’t even notice them unless we’re put in a situation in which we don’t know them. When that happens feelings ranged from isolation and anxiety to circus freak. Being the odd man out is never fun. It’s just too easy to do something wrong. That is exactly what happened the first time my family met Isa’s.

Social Lessons From My Wedding
Isa and I are from very different backgrounds. To say they are different is a massive understatement. Culturally the only way they could be more different is if they didn’t share the same language.

Isa has a liberal Jewish family from New York. I have a conservative Christian family from New Mexico. Her family grew up in the suburbs and the city. My family grew up on farms and ranches in the desert. Her family came here in the last century. Mine was here pre-revolution. You get the point, very different people.

As you can imagine, the first time they met was not comfortable. It was the afternoon before Isa and I were to get married. Everyone was doing their best to not commit a social faux pas. They were all very reserved in their behavior and trying to figure out what was acceptable and what was not. Personally I was sitting in a different room avoiding the whole ordeal.

A Social Rule Gets Violated
Anyway, after what seemed like an eternity my family and I headed out to the car to go back to the hotel. As my brother Greg stepped down from the front steps my then soon to be father-in-law, Jerry, grabbed him and kissed him on both cheeks. Greg promptly became stiff as a board and white as a ghost.

Had I not warned my family that they might get kissed, it may have been a far more uncomfortable situation.

You see my father-in-law had violated an unwritten social rule of our culture. Where I come from kissing is only shared between lovers. Hugging isn’t even accepted by everyone there. So a kiss on both cheeks by another man really shocked my brother.

If it’s difficult for the average adult to follow the unwritten social rules imagine how difficult it must be for a child who has a social skills disorder. For them every day is like trying to understand a different culture. It’s like a pop quiz that they’re not prepared for. Imagine how stressful that must be.

Social Skills Must Be Learned
It is a mistake to assume that just because a child is intelligent or has a great vocabulary that he will pick up social skills on his (or her) own. Social competency doesn’t have anything to do with IQ. You can be perfectly intelligent and still struggle socially. That’s because social skills have to be learned.

The analogy I always give is math. Some people just get it, while others struggle with it.

I flip numbers, so I’m someone who struggles with it. That doesn’t mean I can’t learn it. It doesn’t mean I’m stupid. It just means that there is a specific way I have to learn it. I can learn just about anything else by any method I choose. I can see it, hear it or do it, doesn’t matter unless it is math related. If it is math related I have to see it, hear it and do it frequently in order for it to stick.

It’s similar for children who have trouble socially except social interactions are far more complex than math. Whereas math has clear and logical rules, social interactions are heavily influenced by emotions and context. If you don’t have some understanding of emotion and context it makes it very difficult to act in a socially acceptable manner.

The Road To Good Social Skills
A child cannot learn emotion and context by being taught social skills in isolation. While it is important in some cases to either start with or focus on the behavior, social skills need to be taught in a broader context that either is or feels like a natural environment.

Think about it. What good does it do to teach your child to look you in the eyes if he doesn’t understand why? It’s like handing him the formula for division without explaining how and why to use it. In fact a frequent complaint of children who have been taught skills in isolation is that they did not understand why they should use the skill. Once they understood why they should use a skill improved how they used it.

Appropriate social skills instruction seeks to create social understanding. Unfortunately very few programs have this objective. That is one of the main things that hold them and the children they work with back.

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You hear the labels all the time. The “in crowd”, soccer moms, NASCAR dads, Liberals and Conservatives, the list goes on for almost infinity. Every label represents an “Us” to which everyone outside of it is a “Them”.

We all hold “them” in contempt. However, when you get down to it as humans we’re not that different.

We’re all flesh and blood. We all care about our families and friends. We all like to have fun. None of us like to feel pain. Still, despite our similarities we can’t escape viewing our world through the prism of “Us and Them”.

The Role of Social Behavior In Our Survival
Ultimately what makes someone an “Us” is their ability to follow a set of rules that define our social behavior. This is a survival strategy that has been with us since our ancestors first started organizing into groups. In order for the group to be able to survive it had to be cohesive in its thinking and behavior.

Dividing people into “Us” and “Them” is also how we determine who we can trust and who we cannot. Fairly or not your clothes, your car, your house, your mannerisms and everything else about you symbolize the “Us” you belong to. As neuroscientist Terence Deacon puts it, humans are the “symbolic species”.  We all do something to fit in and be part of the crowd. We may all do it with different things, but we all do it.

That is why our social skills are so important. Our ability to adapt and fit in is a key to our very survival. If someone lacks the ability to fit in they cannot become an “Us”. Without becoming an “Us” they cannot survive. Where will one get the money needed for survival if they are unable to show that they are one of Us?

It’s no secret that employers look not only at your skill but how you will fit into their culture when you are being interviewed. They know that your social ability is at least as important if not more important than your actual technical skill. It’s much easier to teach a technical skill than it is to change a behavior.

Social Ability More Important Than Academic Ability
While both are important, it is believed that our ability to adapt to our social environment is more important to our future success than anything we learn in academics.  The more connected we become as a species the more important our ability to socially adapt will become.

It’s a mistake to think that social skills are solely about making friends. Social skills affect our ability to function in our daily life. In order to be independent we must be able to navigate through social situations.

Our social skills define our ability to navigate every situation that involves more than one person. We have to consider the outcomes and consequences of our decisions. Since few if any decisions impact only one person our social skills play an important role in almost everything we do.

Why Every Communication Is A Social Event
Even my writing this must be considered in a social context. I must be able to consider your perspective. Will you enjoy what I write? Will you get the point I’m trying to make, or will you infer something else all together. Will you find this offensive? I have to consider all of this when I write.

This is referred to as perspective taking. It’s the ability to empathize with others and to see their point of view.

While I cannot do it here, if you and I were speaking I would be able to judge your reaction by your tone of voice, posture and any manner of other social cues. I could then modify what I was saying based on your response. It might involve taking the subject further or dropping it all together if I see that is something that upsets you.

In other words by taking your perspective I am able to see if I am violating your social rules or not. In turn you are deciding whether or not I have. Consciously or subconsciously we are constantly making these judgments. We cannot escape this.

We all are deciding who belongs with “Us” and who belongs with “Them”. Therein is the importance of having effective social skills. Without them how can someone become part of “Us”?

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Social skills difficulties sneak up on most parents. Suddenly the child who had played alongside the other kids is now feeling isolated and unable to make friends.

This happens because of how quickly social interactions change once a child moves out of toddlerhood. While being able to take turns was once enough, now the child must be able to grasp the nuances of both verbal and non-verbal language. They must also be able to distinguish between literal and non-literal language. And while we take it for granted, this is not an easy thing to do.

The worst part of the whole thing is that these children want to make friends. They just do not know how to.

He Just Doesn’t Get It
Parents often tell me it is hard to understand why their child “just doesn’t get it”. One reason is because their child is unable to learn social skills through experience like other children. Instead, he must be taught.

While not limited to them, social skills difficulties are key components to learning, language and Autism Spectrum disorders. Unfortunately the research shows that few of these children are getting the help they need.

The consequences of this are devastating. Children who have trouble socially are at greater risk of suffering from anxiety, depression, substance abuse and social isolation. They are also at greater risk of being bullied since they are unable to pick up on social cues.

The Road To Negative Labels
Many parents get frustrated when they place their children in settings with children who have good social skills. They hope that their child will learn from their peers, but since their child is unable to pick up on social cues they don’t.

While this environment is important to practice new skills, it is not the place to learn these skills. Everything moves too quickly and sets the child up for failure.

It also risks them being misunderstood by the other children and adults, this leads them to being labeled the “weird”, “mean” or “bad” kid. For example a child who’s overly blunt may be prone to hurt another child’s feelings without meaning to. Even though he does not understand what he is doing wrong he may get in trouble. Unfortunately, when children are given these negative labels they often feel it is their responsibility to live up to them.

Your Words Matter
There is a little boy I know well who I will call Brian. Brian is an active little boy with some attention and sensory issues. Brian is also a very bright boy who doesn’t miss a thing.

One day when Brian was doing something he should not be doing I asked him why he was doing it. He replied “Because I am Brian”.

I shared this comment with his parents who now work hard at avoiding negative labels. However, while we can control the labels given to our children in our own homes, we cannot control how they are labeled outside of our homes.

The Problem With Waiting
Social skills problems do not go away on their own. As social situations become more complex social skill difficulties become more obvious.

The best thing to do for your child is to work on these skills early. This will help your child effectively interact with his peers.

Do not push these needs aside until they become overly apparent. If you feel your child is at risk, or is having difficulty making friends, get help.

As I mentioned earlier, children with autism spectrum disorders as well as learning disabilities have social skills deficits as a central feature of their disorder. If this is your child, these needs should be addressed automatically. There is no reason to wait.

Waiting only complicates the situation.

A mom from Nevada recently contacted me and said that her “very smart 11 year old daughter loves school” however, “…she has kids she knows and will talk to, but no real friends. She cries at night and doesn’t want to go to recess or lunch at school.”

I wish I could say such stories are uncommon, but they are not. A Westchester mom recently said of her daughter “All I want is for her to have at least “one” friend so that she does not hate school and she is not so lonely.”

I hear these stories every day. For 15 years I have worked with children who have these challenges in their lives. However, it is still hard for me to see children who are unable to make or keep friends.

At a the last health fair I attended I met a mother who told me that her son who is on the autistic spectrum said, “Mom, I always feel like there is something I am missing and I just don’t know what it is.”

All children want to fit in. And with the help that is available there is no reason for them not to. No child should be a lonely child.

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Theory of Mind is the ability to not only understand that people have different beliefs, motivations, knowledge and moods but also understand how that affects their actions and behavior as well as our own. Theory of Mind is a necessary component of perspective taking.

Perspective taking refers to our ability to relate to others. It is our ability to perceive someone else’s thoughts, feelings, and motivations. In other words it refers to our ability to empathize with someone else and see things from their perspective.

Most people can intuitively tell how someone else feels in a conversation. When they speak to someone who’s looking around and not paying attention, they perceive the person is not interested in the conversation or is distracted for some reason. They know if they see tears in the person’s eyes that the person is upset.

Not a Sign of Intelligence
Someone with Theory of Mind Impairment will also have poor perspective taking skills. They will miss many of these cues. In some cases they may miss all of these cues. As with many other factors contributing to social skills deficits, one can be of gifted intelligence and not have effective perspective taking skills.

Theory of Mind and Perspective taking skills begin to develop in the womb and continue throughout our lives. A newborn child should try to imitate facial expressions within the first few weeks of life. This is quickly followed by pointing, the development of language and joint attention by twelve months.

By Age Two
By age two, the ability to understand what is in the mind of others and that they are different with their own needs and desires. Children at this age are learning how to “get their way” through give and take as well as manipulation. They are also becoming aware of other’s efforts to manipulate their behavior and are developing strategies for dealing with such attempts.

Children who have difficulty understanding the motivations of themselves or others have some level of perspective taking dysfunction. This is also true of children who have difficulty developing strategies for give and take.

These children will continue to have difficulty with social situations throughout their lives. Social Skills Therapy is necessary.

If you are concerned about your child’s social development either call (914) 488-5282, or fill out the form on the right side of the page for more information about how we can help.

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