Social Cognition and Theory of Mind

Recently at an Autism Parent Support group, the discussion was about Social Cognition and Theory of Mind.  How many of us have experienced our Autism child lack the basic social skill in some degree?  I'm sure at one time or another this has happened.  Example, one story that was discussed was a child who was home with another family member.  The family member was in a different room and had fallen.  The child heard the commotion and ran to see what had happened.  The relative said, "go get your mom, I need some help", the child replied "I'm busy" and walked away.  In my own experience, my son has told other children who were being noisy in a store or other public area to quiet down, in a very assertive tone.  We've gotten some strange looks from parents when he does this... heck I would probably do the same thing.  So I've told him that is not his job and not to do that.  Or in other cases, kids will talk to my son but because he's very fidgety and hyper, they give him an odd look.  

Here are some of the highlights that the group host provided to us:

Social Cognitive Impairments in Autism 

• Inability to infer or empathize others' desires & feelings
• Inability to consider what others know
• Inability to consider what others are thinking
• Inability to infer others' beliefs and opinions
• Inability to consider unintentional behaviors of others 
• Inability to infer communicative intent
• Inability to understand or engage in deception
• Inability to coordinate multiple social cues in a given social scenario

So the question is, can a "Theory of Mind" be taught?  Here are some examples that were provided on how this can be address:

• Train for generalization in a one-on-one setting
• Teaching "rules"
• Role Play / Rehearsal
• Reinforcement / Natural Contingencies
• Generalization to peer iterations

"What is “Generalization?”  It’s a “spreading” or “expansion” of teaching, beyond what was directly or intentionally done.  Example: explicitly teach turn-taking to a child at school and then the child starts taking turns at home with siblings or friends, even though no one ever tried to teach turn taking at home" source

Teaching desires

Child's desires

   -Child identifies what he/she wants

Others' desires 

   -Caregiver express/demonstrates desire.  Child identifies/responds to others' desire

   -Target finding out others' desires.  Asking "which one do you want?"

Increase Social-Cognitive Repertoire

   -Begin with obvious reactions, then reduce

   -Generalize to natural social situations

      -Have the child offer snacks to peers

      -Have the child pass out pieces during a game

      -Have the child find out what peers want to play

Teaching Knowing

Child's perspective

   -Target identification of what and how child knows:  "I don't know what the color your socks are because      I can't see them"

Others' perspective

   -Target identification of what others know and how:  "You don't know what I had for breakfast because I       didn't tell you"

   -Target generalization to social interactions

Increase Social-Cognitive Repertoire

   -Utilize visual prompts to increase comprehension

   -Generalize social situations

   -Rehearse and reinforce:

      -Inhibiting telling what others already know

      -Inhibiting asking questions and know answers

      -Providing enought background information for the listener to understand

      -Applying concepts of know to Social Play: Secret/Strategy Games, Hide-n-Seek

Teaching Beliefs and False-Beliefs

Child's own beliefs and false-beliefs

   -Child identifies earlier false-belief:  "I thought it was in the garage"

Others' perspectives

   -Observes others' experiences and infers others' beliefs:  "She thinks I'm doing my homework."

   -Target predictions of others' emotions/behaviors:  "He'll go to the park because he thinks his friend is              there"

Increase Social-Cognitive Repertoire

   -Do Not teach rote responding via mass trialing of scenarios

   -Utilize natural situations

   -Use visual prompting to help child recall earlier  beliefs.  Demonstrate what others think

   -Inferring beliefs must be generalized to variety of stimuli and social situations

      -Characters in stories

      -Characters in videos

      -Creating false beliefs in others: "tricks" and jokes

Advance Beliefs: Intentions

   -Target a variety of Intentional / Unintentional behaviors

      -Accidents vs. "On purpose"

      -Mistakes

      -Playful joking / Mean joking / teasing

      -Lying of inferring intention

   -Target a variety of means 

      -Facial expressions

      -Body language

      -Vocal qualities

      -Previous experience

"Social interaction is not a static or segmented process. Social interaction is a subtle, reciprocal dance where friends continually assess how one’s own behavior is being perceived by others and adjusting accordingly. There are countless “unwritten” rules, rapid perspective taking requirements, and a demand to continually “socially filter” how you communicate to various listeners. Learners on the autism spectrum often lack this intuitive social thinking process of aiming to please and attend to other people in their interactions. Rather, conversations and relationships can appear one-sided or superficial in nature. Children with ASD miss the subtle nuances of non-verbal communication. They are unaware of unwritten social rules. Lastly, children with ASD can be hyper-focused on their own intense interests and have difficulty dampening or managing their own emotions when facing the unpredictability of the social world. It is for these reasons that an approach to increasing social competence should incorporate all aspects of Pragmatics: perspective taking, emotion/non-verbal communication awareness and expression, conversation skills with a social cognitive slant on analyzing skills, as well as teaching behavioral friendship skills." source