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And to finish off the Why section a little bit of psychology for you.   We're going to look at some areas that, like before, you probably have going on without you being aware of it.   Once again, its something we're all better or worse at, and people with autism in particular seem to struggle with.   Understanding these things will hopefully help you understand your child and the difficulties they face a little more.
Theory of Mind

Theory of mind the ability to attribute mental states (beliefs, intents, desires, pretending, knowledge, emotions etc.) to yourself and others.   It also enables you to understand that others have beliefs, desires, and intentions that are different from your own.

We use our theory of mind to work out what is going on in other people’s heads, we read their body language, use our knowledge of people and how they think and act (based on information gained over time) and also our knowledge of ourselves and how we think.

Body Language

Without theory of mind, we simply do not understand the internal states of others, that they have the potential to be different to our own.   This can impact our ability to communicate - if what’s in your head is the same as in mine, why would I need to bother turning what is in my head into words and then throw those words at you?

It also takes away a reason to regulate or modify our behaviour.   If I am unaware of what is going on in your mind (mind-blindness), then I will be totally unaware of the impact of my behaviour on you.   If the behaviour I’m displaying is because I am upset or scared, and I see you being upset or scared when I display my behaviour, I may well assume that, as what’s in your head is the same as in mine, then you are displaying outward signs of being upset or scared for the same reason as me, rather than as a result of what I am doing.

People with autism are thought to have poorly developed or absent theory of mind.   This has close links with some of the other features of autism.   If we think about the triad of impairments, we know that people with autism struggle with social interaction, social communication and imagination.

When neuro-typical (not autistic) people use their theory of mind, they use their social communication skills (body language etc.) to read the person they are observing, their social interaction skills to gain more knowledge (asking “are you alright?” while taking into account social rules such as when and where it is OK to ask such a question), and their imagination to piece together what they already know about the person, what they know about people in general, and to pull together the ‘bigger picture’ (something else people with autism struggle with - central coherence) of the situation surrounding the person, the context, the history etc.

As previously mentioned, we also use our understanding of ourselves and how we think to build up that picture of what is going on in the other person’s mind.   This includes emotions and how they affect us as well as what can cause them.   Many people with autism have difficulty understanding their own emotional states (a condition called alexithymia) and so may not even have the fully functioning resource of their own minds as a point of reference.

People with autism may also have a learning disability which could also further impact their ability to understand themselves and others.   People with Asperger Syndrome (AS) or High Functioning Autism (HFA) may be able to use their intelligence to understand that other people have different thoughts and feelings to themselves, they may even apply their logic to a theory of mind test such at the Sally-Anne test (see below), but this probably won’t come naturally to them, it won’t be instinctive the way it is for the neuro-typical population.

They may also struggle to generalise that knowledge, once it is learned, and being aware that there is all this stuff going on in other people’s heads that you are unaware of may cause a degree of social anxiety. Theory of mind is thought to develop in neuro-typical people at around four years old.   Some recent research has indicated it may even develop a little earlier.   Many people would argue it possibly takes a back seat during the teenage years, but it is there.

Sally-Anne Test

The Sally-Anne test is a simple test, often performed with dolls, to test theory of mind in children with autism.   Without theory of mind a child would assume that, because they know that the ball has moved, Sally will know it too.

You can read more about Theory of Mind on the web.

Interesting fact: The word 'autism' comes from the Ancient Greek word 'autos', meaning 'self'.   It was coined in 1911 by a chap called Eugen Bleuler, and pinched separately by Leo Kanner and Hans Asperger in the 1940s to describe the children we think of as autistic today.

Executive Functioning
  • These are the processes that allow us to think, act and problem solve.
  • They allow us to generate new ideas and plans.
  • They also allow us to think and plan ahead (using our imagination!).
  • They help us with organising tasks, sequencing them and also multi-tasking (some genders are rumoured to be better than others at this!)
  • They help us cope with changes in routine.
  • To understand the concept of time and waiting.
  • And they help us with making choices.

The above could just be a list of difficulties people with autism face, which is not surprising considering we all have some difficulties in this area.   A lot of our 'neuro-typical' visual and other supports are needed to help us here, including our calendars, sticky notes, recipes and Ikea shelf assembly instructions.

Once again, the good old internet has plenty to say about executive functioning.

Central Coherence
  • This is our ability to see the bigger picture, to 'see the forest not just the trees'.
  • Children who struggle with this may understand individual words but not the sentences they make.
  • They may focus on a seemingly insignificant detail (such as a stain on the carpet) to the exclusion of everything else.
Going to the park
Helping with this is one of the functions of a visual schedule.   It allows children to see what they are doing (or meant to be doing!) now, what they just did and what they are doing next.   It allows them to see where they are in the context of the whole day, rather just seeing the one bit they're on now.   It may help them to transition on to the next activity, or add structure to the day so they can see where they are in relation to something they're looking forward to (going home?).

When we get dressed, we know that each item of clothing adds to the bigger picture that is us fully dressed.   We also use our imagination to hold a picture of our dressed selves so that we know what we're working towards.   For a child with autism, getting dressed may be the same as you or I doing a puzzle without the picture on the box to refer to, and only being allowed to have one puzzle piece at a time.   A getting dressed schedule can really help with this, only Superman is allowed to put his underpants on last!
Research into central coherence and autism has generated mixed results.   You can read more about this here, as with the other areas discussed on this page, its a theory.   The mind cannot be directly observed, so we come up with theories to describe the different functions and processes.   And if you come up with one lots of other people like, you get a Wikipedia page written about you!
I'm often asked about emotional regulation and autism.   Many of the children I work with seem to have great difficulties in this area.   The simple answer is, how can you regulate what you don't understand?
  • Alexithymia is the inability to identify or describe your own emotions.
  • It is commonly a part of autism in varying degrees.
  • It extends to difficulty distinguising and appreciating emotions in others.
  • Can involve an inability to filter emotions not directed at the self.
  • It can involve an inability to control or supress one's own emotions.
  • It also includes problems with linking the bodily sensations associated with emotional arousal to the appropriate emotion.   The most common example of this in my experience is reporting a tummy ache in response to anxiety or anticipation, when infact it may be 'butterflies'.
  • It also affects the way people dream and fantasise.
  • It can lead to very logical, unemotive, 'robotic' thinking.

You can read more about Alexithymia here.   There's also a really good blog that describes the effects of Alexithymia from the perspective of a lady with AS, I strongly recommend that you read it.   I often send it to people if I hear a child with autism consistently becomes distressed whenever another child is told off or is upset, even if that other child is on the TV!