6.6 Developing socio-cognitive skills
Some recent approaches are directed at helping people with autism to establish theory of mind type skills. The rationale, in contrast to behaviour modification, is that this will bring about relatively fundamental psychological change and social adjustment rather than tackling ‘surface’ symptoms. Experimental work by Hadwin et al. (1996) demonstrated a way of teaching mental state understanding to children with ASDs. Patricia Howlin and colleagues (Howlin et al., 1999) elaborated this as a programme for practitioners and carers to use with children (see Box 14).
Box 14: Teaching mind-reading skills
The approach offers detailed materials and instructions for helping children tackle three main areas of mind-reading skills: Understanding emotions; understanding ‘informational states of mind’, such as beliefs; pretend play. In each of these areas the training materials are arranged in order of difficulty so that the child progresses from learning about simple mind-reading skills to more complex ones. For instance, the training material for emotions are arranged to tackle the following skill levels:
Level 1: ability to recognise from photographs facial expressions such as happy, sad, angry, afraid.
Level 2: ability to recognise expressions as in Level 1, but from facial cartoons.
Level 3: ability to predict how a character will feel given a situation depicted in a picture (e.g. fear when an accident is about to happen).
Level 4: ability to identify a character's feelings (happy or sad) according to whether their desires (e.g. to go to the movies) are satisfied.
Level 5: ability to recognise emotions caused by a character's belief about a situation, e.g. a child wants to go to the movies and thinks their mother is taking them.
Figure 10, below, illustrates a teaching page for Level 5. In each area, the teacher works through a whole series of such pictorial examples with the child and tests that the child has understood the principle being taught, before moving on to a different example. In this way the approach seeks to ensure generalisation of the skill across different examples and to the next level of difficulty. The situations illustrated are as near as possible to real-life situations that the child might experience. However, as Figure 10 shows, the approach could be seen as encouraging a ‘pictures in the mind’ notion of how other people think.
Some success has been achieved with these materials, including the key step of helping children to generalise from the materials to situations they have not previously encountered (e.g. Hadwin et al., 1996).
Again, we can use the criteria in Box 11to evaluate this approach:
Theoretical rationale: The programme has a firm grounding in ToM research, which predicts that children will benefit from techniques designed to enhance mental state understanding.
Methodological considerations: Hadwin et al.'s 1996 study constituted an acceptable ‘pilot’, employing appropriate participants and evaluation of the success of the measure. However it may be that what the child learns here is a set of rather ‘wooden’ or theoretical skills for interpreting social situations that will not generalise into skills for entering social interactions.
Ethics: The fact that the child is taught a somewhat ‘mechanical’ view of how minds work could be seen as an ethical problem. This concern is tackled in an interesting, though small-scale, study by Hsiao Yun Chin and Bernard-Opitz (2000). In an intervention with three boys diagnosed with ‘high-functioning’ autism, they focused not on theory of mind per se, but on the conversational skills that are a practical manifestation of theory of mind. They taught the boys the skills of initiating and maintaining a conversation, taking turns and listening attentively, and changing conversational topic. The intervention was moderately successful: one child showed particular improvement, and the parents/carers of all three children rated the training as very effective. Yet the children's performance on experimental tests of false belief showed no improvement as a result of the training, suggesting a dissociation between experimental ‘mind reading’ and practical, everyday skills associated with understanding other minds.
This once again highlights the complex implications of the ToM approach. Theoretical insights are translated here into practical applications, but these applications may, in turn, call for modifications of theory or further revision of the applications.