Asperger’s Syndrome: What Is Theory of Mind?

Colorful marblesThis is the first in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

As a therapist, I see clients with a variety of traits clustered at the high-functioning end of autism, now commonly referred to as Asperger’s syndrome, a term I will use until the DSM-5 makes it no longer accurate.

No two clients with Asperger’s syndrome exhibit the same cluster of traits, nor does any one client exhibit them all. However, there is one element that I recognize as pervasively diminished in all Asperger’s clients. This element is called “theory of mind.”

What is theory of mind? It is a person’s ability to imagine the interior life of another person. This includes understanding why someone else does something, how someone might feel in a certain circumstance, what might be important to that person: in short, it is the ability to put oneself in the mind of another person and see the world from that person’s point of view. Theory of mind means being able to create a theory about the way another person’s mind works.

Theory of mind provides the basis for empathy because if you can walk in someone else’s shoes, you also become capable, by extension, of feeling any pain or delight that person experiences. You understand motivation. You catch a glimpse of fears and dislikes. You get to know the other person from the inside out.

According to autism specialist Simon Baron-Cohen, individuals with Asperger’s syndrome typically have delayed access or no access to this phenomenon of human communication and share a problem that is called mind-blindness. Since interpersonal communication is approximately 65% nonverbal, you can quickly see that not being able to formulate a theory of mind leaves these individuals at a distinct disadvantage in relationship with others because the behavior of other people does not make sense to them.

For parents, this gap can create difficulties when they treat their son or daughter with Asperger’s with the same set of interpersonal expectations with which they treat their other children and assume intact theory of mind capabilities. This can lead to incorrect understanding of the child’s behavior as being intentionally hurtful, for example, when in fact it was based in lack of awareness.

A common test used with children suspected of being autistic is called the Sally and Anne Test:

Sally has a basket. Anne has a box. Sally has a marble. She puts the marble into her basket. Sally goes out for a walk. Anne takes the marble out of the basket and puts it into the box. Now Sally comes back. She wants to play with her marble. Where will Sally look for the marble?

Most children will answer that Sally will look in her basket, because that’s where she put it and that’s where she expects it to be when she returns from her walk. Baron-Cohen discovered that only 20% of children with autism were able to answer correctly. A full 80% answered that Sally would look in the box, because that is where the marble is.

This test is often used to demonstrate the theory of mind deficits in children with Asperger’s syndrome. They believe Sally will look in the box for her marble because they know that’s where it is. They are unable to put themselves into Sally’s mind in order to understand that from her perspective the marble should be right where she left it: in her basket. Can you imagine how unpredictable and irrational the world must appear to a child whose logic is denied in such a manner? This is the world of a child with Asperger’s syndrome.

I work with children to help them build bridges toward understanding the behavior of others, so that they can come to anticipate that their own logical view of the world may not apply in all circumstances. This is one of the primary goals of therapy with these children. It is an attempt to help them experience the world as a safer place than it appears when their logical perspective is consistently shattered by experiences that do not align with it.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Sarah Swenson, MA, LMHC, therapist in Seattle, Washington

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • jarvis

    August 31st, 2012 at 12:55 PM

    must be so difficult for a child to interpret the world and everybody around him!what are the current treatment methods available for this?

    and parents and others around such children need to be so understanding and supportive of a child like this because really a little support from those that the child looks up to would be a great morale booster after all the problems!

  • Simone

    August 31st, 2012 at 2:58 PM

    Seems like I have read somewhere that the character of Sheldon from the Big Bang Theory experiences many characteristics of someone with Asperger’s . I would love to hear some comments form those of you who are not only familiar with this character but the numerous aspects of this disorder to see if you think that that would be accurate. I would also like to know how prevalent this is because I know a whole lot of people who haven’t a clue that the things that they say could be percieved as offensive. I have always chalked it up to them just being Clueless but maybe now there is another name for that. . .

  • BROCK

    August 31st, 2012 at 5:55 PM

    I feel like I am unable to see things from another’s point of vie many times.Not that I would have trouble with the Sally and Anne test but since at least a couple of years I feel my ability to do this has diminished and that is actually affecting in the way I perceive people. I hope everything’s alright?

  • wallace t

    September 1st, 2012 at 6:03 AM

    Believe me, in the business world you don’t have to have Aspergers to have a lack of theory of mind!
    I meet so many so called professionals who have no care at all about what they do to get ahead, they don’t care if they hurt other people or not.
    For the most part I think that it’s ruthlessness, but some of them I honestly think don’t have a clue about how to best make friends and do or say things in a way that does not come off as so abrasive.

  • nate

    September 1st, 2012 at 7:32 AM

    How will clubbing this with autism disorder in DSM V help? Will that open up treatment options or does mere reclassification help the patients in any way? I’m interested in knowing this because a lot of professionals stress upon the need to classify disorders in the right manner ahead of the new DSM.

  • Sarah Swenson

    Sarah Swenson

    September 1st, 2012 at 6:17 PM

    For anyone curious about the upcoming changes in the DSM-5 related to Asperger’s Syndrome and Autism, here is the link that describes the proposed changes:dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=94
    The rationale is that autism is a neuro developmental disorder that will manifest in differing degrees along a spectrum of symptoms from mild (what is now called Asperger’s Syndrome) to severe. I encourage anyone who is curious about this to visit the DSM-5 Development page to follow the progress of the work being done and all proposed changes.

    Wallace, you made a comment about seeing certain behaviors in business professionals. I realize that some corporate environments can be brutal, and that some individuals within them can appear to be without thought or feelings for anyone but themselves. However, Asperger’s Syndrome is a specific clinical diagnosis, and while people may be inept and self-involved to the exclusion of the welfare of others, it is not necessarily as a result of an inability to form a theory of mind, but an unwillingness to care enough about others to do so.

  • Olivia

    September 2nd, 2012 at 4:53 AM

    I am not sure that lumping Aspergers with autism as a diagnosis will actually be a good thing- they may have to exhibit additional symptoms in order to get that diagnosis and I think that all of us see that just because the manual doesn’t indicate that you have one illness or another, it is not always accurate to assume that there is nothing wrong. I know that the diagnosis manuals are helpful but they are not the end all and be all.

    Doctors and providers should still be allowed to use their common sense and years of training to make a diagnosis and not always have to rely on some checklist that may not always be the perfect fit for every patient.

  • Sarah Swenson

    Sarah Swenson

    September 2nd, 2012 at 10:09 PM

    Olivia, I completely agree with you. I don’t think the new DSM-5 will make any difference to practicing mental health clinicians in their work with clients, or in making diagnoses. It certainly isn’t going to change the way I work with clients, and I agree that there is no such thing as one-diagnosis-fits-all, regardless of terminology as described in the DSM. Common sense, clinical training, and experience will prevail.

  • savannah

    September 3rd, 2012 at 7:35 AM

    Theory of mind is something that anyone who ever wants to have great relationships with other people, well, it is something that you really can’t survive very well without. Being able to put yourself into the mind of another is critical to understanding other people and having empathy for how they feel and live.

  • BRADLEY

    September 3rd, 2012 at 11:59 PM

    This seems like a terrible and sad situation for a child to be in.At an age when they cannot fully understand the nuances of the world and how it functions to have your own mind kind of cheat you must be so hard.

    What kind of coping strategies do these kids have to counter this? I would like to have more info because this is the first time I am reading about this and it seems just horrible.

  • Phillip

    September 4th, 2012 at 3:53 PM

    Living with this must be terribly hard, never really having any grasp of what others are communicating to us non verbally. I can usually tell what someone is thinking just by the look omn their face or the way they are standing! If I wasn’t able to read people like this I would think that I would be at a serious disadvantage in many aspects of life.

  • Sally

    September 20th, 2012 at 10:52 AM

    Well, I did the Sally and Anne test and failed! Even after it was explained, I had to go over the story and explaination several times to get a decent understanding and I’m 22. I have trouble seeing things from other peoples views and that creates a lot of tension between family. I dont know if this will make it harder to diagnose female aspies or not. Female traits of aspergers are slightly different from males, and most of us already get misdiagnosed with other conditions, such as depression, bipolar etc. I hope I can can diagnosed before all this stuff begins.. I don’t think they’re making a good decision- they shouldn’t just bung aspergers in with autistic disorder!

  • tielserrath

    December 8th, 2012 at 3:21 PM

    I’m sorry to hear this tired theory trotted out again. The issue with the Sally-Anne test is that the behaviours of autistic people are being interpreted from a non-autistic point of view.

    For instance, as a child, I would have pointed at the box, because that would be the point at which Sally realised the marble had been moved and become angry. My whole being would be focused on this impending anger and it would overwhelm my ability to actually parse the question.

    Also for a lot of autistics, ‘look’ isn’t interpreted as a single event. Some would know that Sally would first look in the basket, and then in the bok. Since she will look in both, but only find the marble in the box, the answer to the question is ‘box’.

    you will note that both these include clear evidence of theory of mind – the knowledge that Sally will be angry: “who moved my marble!”, and the knowledge that Sally will look in several places until she finds her marble, because she wants/needs it.

    The utter failure of the ToM test is that of treating autistic people like lab rats. The knowledge that none of the researchers here thought that a valid question to the Autists was *why* did they give that answer, boggles the mind.

  • jill

    December 4th, 2016 at 9:02 AM

    My 66 yr old husband has aspergers, he responds similarly. We went by a house that had a for sale sign on it for months. The sign was gone, and he immediately states “Oh, i see that house has sold” Well, the house did not sell! The sign was removed for some reason. (Maybe taken off market, maybe taken by kids, who knows) I asked how he knew the house was sold and his answer was because the sign was down. Then feeling defensive he adds he saw people in the yard. Well, once again, people in the yard has nothing to do with the house being sold. They could be workers, neighbors or who knows…..

  • Sarah Swenson

    Sarah Swenson

    December 9th, 2012 at 10:01 PM

    To tielserrath:

    Thank you for your comment. You are precisely right in your comment that the Sally and Anne test looks at Asperger’s Syndrome from the perspective of those who do not have Asperger’s Syndrome. In fact, it is used precisely because of the distinctive differences in responses it elicits, and in that regard it can be diagnostic.

    I am sorry to hear your strong negative opinion of Theory of Mind. I know that as a therapist, I with each of my clients as individuals. They are not lab rats in any sense of the word. They are individuals who come to me because of distress related to the very areas you discuss in your comment.

    It is not that an individual with Asperger’s Syndrome does not have a rationale for reaching a different conclusion about Sally and Anne. It is that this rationale differs from what is considered normative for in such a situation. The implications of this difference can be mildly or severely distressing to an individual.

    I ask every client about the rationale underlying any behavior or choice we are discussing. The fact that I did not include this aspect of the development of the therapeutic liaison between therapist and client does not mean therapists stop at the Sally and Anne test. It is an indicator, not a label; an arrow, not a means of treating anyone like a lab rat, or as anything less than an individual whose experience of social anxiety has brought him or her into my office for help.

    I don’t use this test with every client. I use it with very young children on occasion, however, and in those cases it becomes part of the basis of psycho-education in our work together.

    If you have any further questions or comments, I would be happy to hear from you.

    Thank you for taking the time to write.

  • tielserrath

    December 15th, 2012 at 8:43 PM

    Your article states:

    Theory of mind provides the basis for empathy because if you can walk in someone else’s shoes, you also become capable, by extension, of feeling any pain or delight that person experiences. You understand motivation. You catch a glimpse of fears and dislikes. You get to know the other person from the inside out.

    According to autism specialist Simon Baron-Cohen, individuals with Asperger’s syndrome typically have delayed or no access to this phenomenon of human communication…

    May I quote from a recent comment on a UK national newspaper?

    “My understanding that lack of empathy is a characteristic is based on what is written by relevant organisations and experts etc who know far more about the topic than me, Other comments on this thread suggest that some others, laymen such as me, understand the same.

    So I suggest you direct your concerns direct to the appropriate experts and organisations…”

    Except when autistic people such as myself ‘direct our concerns’ we’re met with a wall of indifference.

    My issue is not how you behave with your clients. My issue is with the repetition of a stereotype that is untrue and hugely damaging to people on the spectrum. Your web pages come up in the first 10 if you do a search on ‘adult autism’. Therefore you are disemminating facts to a wide audience, likely to be composed in significant part of employers, colleagues and anyone else who finds themselves interacting with an autistic. Can you imagine what it is like when everyone you meet believes you have no empathy? Have you any idea how people use it to justify bullying, overruling autonomy, or anything else they want to do?

    Autistics ‘lacking empathy and theory of mind’ has been extensively debunked. But unfortunately it’s autistics who have debunked it, and when we ask you to respect that, and to assist us in disseminating this new information, you stonewall.

  • Diane M

    June 14th, 2016 at 5:14 AM

    I have been living with an aspie partner for 43 years, on the verge of divorce, Don’t tell me we don’t understand the ToM difference. When many, many families and marriages are falling apart, when we the NT end up in years of therapy because of the damage done to us by Aspergers. Go to those who have been living with them for decades, YOUR EYES WILL BE OPENED. It is a serious dysfunction, maybe not to the casual observer, but to the spouses or parents of ASperger it is a living hell!!

  • tielserrath

    December 15th, 2012 at 8:48 PM

    Sorry about the typo. ‘disseminating’.

  • beanspails

    December 16th, 2012 at 4:17 PM

    Hear! Hear!, “tielserrath”!

    I took the Sally-Anne test a week ago and Sally looked in the basket. Then Sally would be angry(a reaction to incredulity)when the marble was not where she had left it. She may look in the box or she may ask Anne for information before looking in the box as that box belongs to Anne.

    My process for the Sally-Anne test was instantaneous but I saw the action and felt the emotion (glad, sad or mad) of each possibility.

    I can sometimes predict the most probable or likely sequence. These actions, sequences of actions, and connected emotions are coded on cards and retrieved by association. I call my process, “spinning the Rolodex.”

    Sometimes a reaction is funny when the card doesn’t match the situation but that humour doesn’t balance the “blank” of not having an association.

  • Anonymous Poster

    March 18th, 2013 at 5:16 PM

    I think this applies to young children with asperger syndrome. However I think you’re wrong when it comes to adults. Most adults with asperger have a theory of a mind. Most articles make people with aspergers sound worse than they actually. Or usually when they write these articles, they’re mostly referring to kids with Aspergers.

    Go to Wrongplanet forums, there are a lot of adults with Aspergers.

    I would know because I have Aspergers myself.

  • Sarah Swenson

    Sarah Swenson

    March 19th, 2013 at 4:07 PM

    Dear Anonymous Poster:

    Thank you for reading my post and for taking the time to comment. I can see that it might serve well if I were to preface an article with the caveat that there is no such thing as a “one size fits all” description of individuals along the autism spectrum. It is a spectrum, after all, and there is infinite variability.

    Fundamentally, however, the Theory of Mind issues are a starting place when discussing Asperger’s Syndrome/high functioning autism. If this does not apply to you, I apologize if I did implied that it applies to everyone and to the same degree.

    However, I don’t ever use the word “worse” when describing individuals with Asperger’s Syndrome. It is not something bad. There is no judgment attached to having Asperger’s Syndrome, anymore than there is a judgment attached to having diabetes. Asperger’s Syndrome is simply another way of viewing the world, and, as such, it comes with its share of both advantages and disadvantages. There are psychotherapeutic gains from counseling for any perceived disadvantages that may bring stress into the life of an individual. That is what I offer in my clinical practice to those who seek my help.

  • Jean

    September 13th, 2016 at 12:11 PM

    I would say its the majority of society without Asperger’s have no Theory of Mind. They will echo the same mental model rather than get to know the person or client from the Social Model. It is surprising how this ToM test is still being used on adults when it was created for children. Are you telling me that with all these qualified professionals in these organisations, neither can put their ToM heads together and come up with one for adults with Asperger’s? Doesn’t that mean those who say we have no ToM, it is actually the ones treating and counselling us who do not have it at all? After all these years I’ve come to realise the trick those who keep on echoing “We’re all on the Spectrum somewhere” , tend to be people with undiagnosed ADHD and live in shame to reveal their learning difference yet bully us instead. They live in the fantasy land, not the person with Asperger’s. And, use projection as a way to communicate that they are empathising when in fact they are referring to their own emotions and using words based on their wiring and learning style i.e. that ‘sounds like’ you are angry; when in fact the person with aspergers is frustrated or passionate about what they are saying. Many neuro-typicals cannot explain the reasons why they do the things they do and require extra time to process when asked and they do not have a well planned stored up automatic response to give. Yet, the person with Asperger’s is expected to readily explain their reasons why all the time and reel off answers when that is not who they’re created to be. I see and understand the one and only ToM example Sally has a basket and a marble & Anne has a box, much differently.
    When Simon Baron-Cohen tested the 100 children and came to the realisation 20% got it right and the 80% got it wrong, he too was looking at this through the eyes of the 20%. He is wired like them and definitely would say the 20% are right. Baron-Cohen could be left-brained like these children. If he was right brained, would he have said the 80% were right too? Just because the majority says something is right, is it really? What if the majority of society are incapable of seeing holistically ie being in another person’s shoes? And are using this as a means to cover up their own incapability of showing empathy? The 80% are the smart, intelligent ones. Because if you read that out logically with them in the room, looking under Anne’s box is the right answer. If they were all out of the room when the marble was changed, the 80% still got it correct, as they most probably have a gift to know that they would be tricked. There are many people with Asperger’s who are Empaths and may not know it. The majority of persons who I’ve come in contact with without Asperger’s subtly copy the words I’ve spoken to make it sound as if they have empathy, when in fact they haven’t heard what I am saying. So, because I require more time to process, I am labelled as lacking empathy etc, when in fact it is person’s who are afraid to express their emotions apart from in words are the ones who have a problem. It is called: “Afraid to be Real”. Quite a lot of have undiagnosed ADHD, who are quite good actors and they’ve learned ways to disguise their own disability to make it seem, sound and look like they have the soft skills and the person with Asperger’s does not.
    Good actor’s who prefer others to think and come up with the answers, rather than using their own heads themselves. Copy and pasting is their strengths and using outdated information to make it ‘seem, sound and look like’ they are quite knowledgeable.

  • Alicia S.

    October 22nd, 2016 at 7:32 PM

    You know I still have this problem and im 22 years old, when i was 2 a doctor told my mother that I have aspergers. I grew up with no friends, no empathy for others, i felt like a robot. Even more so i was bullied most of my childhood and teenage years. I felt like a alien on the planet. I now help people understand more and more about it. Their is no cure and barely any treatments. However as a severe AS I will say I met a man who didn’t care about my AS and we are still together, understanding ones feelings and putting yourself in anothers mind nor place is very hard. I now look at my AS as a blessing because one man changed my view on the world. Yes I still struggle with relationships, spelling sometimes lol but I can say i am not a robot anymore, it just takes the right person and the right kind of help in another view.

  • Aaron

    February 22nd, 2017 at 12:07 PM

    I think this test shows a fundamental failure to understand how the AS mind works. It’s not that we don’t have a theory of mind. There was never any point where I had trouble understanding that Sally would first look for the marble in the basket. That much is clear. I can see, also, that I might have answered this question incorrectly when I was younger. The problem, however, is not in my theory of Sally’s mind, but in my theory of the mind of the person asking the question.
    What are YOU thinking? What problem are you trying to solve? The question is clearly a trick question, because the answer is so obvious that there must be more to it. The AS child picks up on this, and connects Sally’s problem of finding the marble, with the problem of answering the question.
    The child will recognize that there is subtext to the question; that what you’re trying to learn has nothing to do with Sally or her marble; that it’s about him/her. Without knowing exactly what you’re trying to find out, they will treat it as a test, and since the only thing being asked about here is how Sally will go about looking for the marble, the wording is thus abstracted to mean “where will Sally look to find the marble”, and the obvious answer is “in the box”.
    Ultimately, there’s nothing wrong with our theory of mind. It’s our theory of language that is different.
    The ordinary child with answer the question directly, because they have no inkling that there’s more going on here than just figuring out what Sally thinks. The AS child will answer wrong, because they realize that there IS more going on, but not that it has nothing to do with the test itself.

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