Hypothesis regarding theory of mind in autistic people
Not to be confused with aphantasia, the inability to produce mental images.
Mind-blindness, mindblindness or mind blindness is a theory initially proposed in 1990 that claims that all autistic people have a lack or developmental delay of theory of mind (ToM), meaning they are unable to attribute mental states to others.[1][2][3] According to the theory, a lack of ToM is considered equivalent to a lack of both cognitive and affective empathy.[4] In the context of the theory, mind-blindness implies being unable to predict behavior and attribute mental states including beliefs, desires, emotions, or intentions of other people.[5] The mind-blindness theory asserts that children who delay in this development will often develop autism.[4][6]
One of the main proponents of mind-blindness was Simon Baron-Cohen, who later pioneered empathising–systemising theory.[6] Over the years, the mind-blindness hypothesis has faced criticism from the scientific community[7] due to inconclusive empirical evidence, mixed findings with different ToM tasks, repetitive failed replications of some (but not all) classic ToM studies,[8][9][10][11] and consistent evidence (including some studies by Baron-Cohen) of substantial heterogeneity of autistic people in ToM and empathy measures.[12][13][14][15][16]
Mind-blindness is defined as a state where the ToM has not been developed in an individual.[1] According to the theory, neurotypical people can make automatic interpretations of events taking into consideration the mental states of people, their desires, and beliefs. Individuals lacking ToM would therefore perceive the world in a confusing and frightening manner, leading to a social withdrawal.[1] The theory was based on the assumption that biology is linked to autistic behavior, so it was expected that a delayed development or lack of ToM would lead to additional psychiatric complications. Research into a model with more than two categories was also considered.[1]
Mind-blindness, a lack of ToM, was later theorised to be equivalent to a lack of empathy,[4] although research published a year later suggests there is considerable overlap but not complete equivalence.[17] It was empirically demonstrated that processing of complex cognitive emotions is more difficult than processing simpler emotions. In addition, evidence existed at the time that autism was not correlated with the failure of social bonding and attachment in childhood. This was interpreted to suggest that emotion is a component of social cognition that is separable from mentalizing.[3]
Biological basis
Superior temporal sulcus
Since the frontal lobe is associated with executive function, it was predicted that the frontal lobe plays an important role in ToM; that executive function and ToM share the same functional regions in the brain.[18] Damage to the frontal lobe is known to affect ToM,[19][20] partially confirming this hypothesis. From a 2000 study, it was found that a neural network that comprised the medial prefrontal cortex, the anterior cingulate cortex, the circumscribed region of the anterior paracingulate cortex and the superior temporal sulcus, is crucial for the normal functioning of ToM and self monitoring.[5][21] Although there is a possibility that ToM and mind-blindness could explain executive function deficits, it was argued that autism is not identified with the failure of executive function alone.[22] It has also been shown that the right temporo-parietal junction behaves differently in those with autism,[23] and the middle cingulate cortex is less active in autistic people during mentalization.[24]
History and relationship to autism
Mind-blindness of autistic people relative to non-autistic people
In an attempt to empirically explain the tendency of autistic people to avoid eye contact, a hypothesis was proposed in 1995 that autistic children fail to "read" the eyes of others.[2] This hypothesis was tested with participant performance on false-belief tasks and detecting gaze shifts.[25] In the moral blindness hypothesis study, some evidence existed to support this hypothesis. At the time there was insufficient evidence to support a generalization to explain facial processing difficulties and affective sensitivity, common characteristics of autism, with this hypothesis. In 2001, it was suggested that the mind-blindness hypothesis may explain more severe symptoms of autism, including social withdrawal and social skill deficiencies.[3] With good robustness, it was found that a lower performance on mentalization tasks correlates with autism, suggesting mentalization theory as an effective explanatory model of autism, especially for social skill deficiencies. However, the generally unclear physiological basis of mentalization at the time limited a broader understating of the correlation.[3]
In the 1996 book Theories of Mind,[26]:258Peter Carruthers argues in support of the mind-blindness hypothesis in spite of inconclusive evidence for its generalisation. Recognising the hypothesis has lost popularity, Carruthers argues this is mainly due to the disregard of its proponents to consider the perspectives of autistic people.[26]:259 The latter view is shared by David Smukler in his 2005 analysis of the history of the ToM in autism research.[11]
The assumption that autism is a homogenous condition underpinned by a ToM deficit, genetics, neurological abnormalities, or a 'failure of understanding' as implied by the mind-blindness hypothesis was questioned shortly after its publication.[10] This contrasts with autism as heterogeneous.[11] There is now a large pool of strong evidence supporting the heterogeneity of autism,[27][28][29] and general scientific consensus accepts this as contrary to the original mind-blindness hypothesis, although there has existed some disagreement that heterogeneity is incompatible with alternative mind-blindness definitions.[11]
An author of the original mind-blindness hypothesis, Simon Baron-Cohen, later published foundational research in empathising–systemising theory, which asserts there exists neurological sex differences in autism,[30] and that such differences are not due exclusively to socialization.[31]
Mind-blindness of non-autistic people relative to autistic people
The double empathy problem, first proposed in 2012 by Damian Milton, is a theory in opposition of the mind-blindness hypothesis. It proposes that social and communication difficulties present in autistic people are due to a reciprocal lack of understanding and mutual differences in communication style between autistic and non-autistic people, as opposed to an asymmetric theory such as the mind-blindness hypothesis.[32] There is a growing body of evidence supporting the double empathy problem.[32][33] A possible explanation supported empirically is that the reciprocal lack of understanding is because "we interpret others’ actions according to models built through experience with our own actions".[34]
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a diagnosis formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.
Empathy is generally described as the ability to take on other's perspective, to understand, feel, and possibly share and respond to their experience. There are more definitions of empathy that include but are not limited to social, cognitive, and emotional processes primarily concerned with understanding others. Often times, empathy is considered to be a broad term, and broken down into more specific concepts and types that include cognitive empathy, emotional empathy, somatic empathy, and spiritual empathy.
The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere. It is parted from the parietal lobe by a groove between tissues called the central sulcus and from the temporal lobe by a deeper groove called the lateral sulcus. The most anterior rounded part of the frontal lobe is known as the frontal pole, one of the three poles of the cerebrum.
In psychology, theory of mind refers to the capacity to understand other people by ascribing mental states to them. A theory of mind includes the understanding that others' beliefs, desires, intentions, emotions, and thoughts may be different from one's own. Possessing a functional theory of mind is crucial for success in everyday human social interactions. People utilize a theory of mind when analyzing, judging, and inferring others' behaviors. The discovery and development of theory of mind primarily came from studies done with animals and infants. Factors including drug and alcohol consumption, language development, cognitive delays, age, and culture can affect a person's capacity to display theory of mind. Having a theory of mind is similar to but not identical with having the capacity for empathy or sympathy.
Sir Simon Philip Baron-Cohen is a British clinical psychologist and professor of developmental psychopathology at the University of Cambridge. He is the director of the university's Autism Research Centre and a Fellow of Trinity College.
A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. Thus, the neuron "mirrors" the behavior of the other, as though the observer were itself acting. Mirror neurons are not always physiologically distinct from other types of neurons in the brain; their main differentiating factor is their response patterns. By this definition, such neurons have been directly observed in humans and primate species, and in birds.
The Sally–Anne test is a psychological test originally conceived by Daniel Dennett, used in developmental psychology to measure a person's social cognitive ability to attribute false beliefs to others. Based on the earlier ground-breaking study by Wimmer and Perner (1983), the Sally–Anne test was so named by Simon Baron-Cohen, Alan M. Leslie, and Uta Frith (1985) who developed the test further; in 1988, Leslie and Frith repeated the experiment with human actors and found similar results.
The empathising–systemising (E–S) theory is a controversial theory on the psychological basis of autism and male–female neurological differences originally put forward by English clinical psychologist Simon Baron-Cohen. It classifies individuals based on abilities in empathic thinking (E) and systematic thinking (S). It measures skills using an Empathy Quotient (EQ) and Systemising Quotient (SQ) and attempts to explain the social and communication symptoms in autism spectrum disorders as deficits and delays in empathy combined with intact or superior systemising.
Dame Uta Frith is a German-British developmental psychologist and emeritus professor in cognitive development at the Institute of Cognitive Neuroscience at University College London (UCL). She pioneered much of the current research into autism and dyslexia. Her book Autism: Explaining the Enigma introduced the cognitive neuroscience of autism. She is credited with creating the Sally–Anne test along with fellow scientists Alan Leslie and Simon Baron-Cohen. Among students she has mentored are Tony Attwood, Maggie Snowling, Simon Baron-Cohen and Francesca Happé.
Autism or autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as persistent deficits in social communication and interaction. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the underlying spectrum. For example, some are nonverbal, while others have proficient spoken language.
The imprinted brain hypothesis is an unsubstantiated hypothesis in evolutionary psychology regarding the causes of autism spectrum and schizophrenia spectrum disorders, first presented by Bernard Crespi and Christopher Badcock in 2008. It claims that certain autistic and schizotypal traits are opposites, and that this implies the etiology of the two conditions must be at odds.
Empathy quotient (EQ) is a psychological self-report measure of empathy developed by Simon Baron-Cohen and Sally Wheelwright at the Autism Research Centre at the University of Cambridge. EQ is based on a definition of empathy that includes cognition and affect.
Evolutionary psychiatry, also known as Darwinian psychiatry, is a theoretical approach to psychiatry that aims to explain psychiatric disorders in evolutionary terms. As a branch of the field of evolutionary medicine, it is distinct from the medical practice of psychiatry in its emphasis on providing scientific explanations rather than treatments for mental disorder. This often concerns questions of ultimate causation. For example, psychiatric genetics may discover genes associated with mental disorders, but evolutionary psychiatry asks why those genes persist in the population. Other core questions in evolutionary psychiatry are why heritable mental disorders are so common how to distinguish mental function and dysfunction, and whether certain forms of suffering conveyed an adaptive advantage. Disorders commonly considered are depression, anxiety, schizophrenia, autism, eating disorders, and others. Key explanatory concepts are of evolutionary mismatch and the fact that evolution is guided by reproductive success rather than health or wellbeing. Rather than providing an alternative account of the cause of mental disorder, evolutionary psychiatry seeks to integrate findings from traditional schools of psychology and psychiatry such as social psychology, behaviourism, biological psychiatry and psychoanalysis into a holistic account related to evolutionary biology. In this sense, it aims to meet the criteria of a Kuhnian paradigm shift.
The history of autism spans over a century; autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.
Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
Nonverbal autism, also called nonspeaking autism, is a subset of autism spectrum disorder (ASD) where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5 are still nonverbal 10 years later.
Caetextia is a term and concept first coined by psychologists Joe Griffin and Ivan Tyrrell to describe a chronic disorder that manifests as a context blindness in people on the autism spectrum. It was specifically used to designate the most dominant manifestation of autistic behaviour in higher-functioning individuals. Griffin and Tyrell also suggested that caetextia "is a more accurate and descriptive term for this inability to see how one variable influences another, particularly at the higher end of the spectrum, than the label of 'Asperger's syndrome'".
The mechanisms of autism are the molecular and cellular processes believed to cause or contribute to the symptoms of autism. Multiple processes are hypothesized to explain different autism spectrum features. These hypotheses include defects in synapse structure and function, reduced synaptic plasticity, disrupted neural circuit function, gut–brain axis dyshomeostasis, neuroinflammation, and altered brain structure or connectivity. Autism symptoms stem from maturation-related changes in brain systems. The mechanisms of autism are divided into two main areas: pathophysiology of brain structures and processes, and neuropsychological linkages between brain structures and behaviors, with multiple pathophysiologies linked to various autism behaviors.
Autistic masking, also referred to as camouflaging or, more broadly, neurodivergent masking, is the conscious or subconscious suppression of autistic behaviors and compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical. Masking is a learned coping strategy that can be successful from the perspective of autistic people, but can also lead to adverse mental health outcomes.
The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher. This theory proposes that many of the difficulties autistic individuals face when socializing with non-autistic individuals are due, in part, to a lack of mutual understanding between the two groups, meaning that most autistic people struggle to understand and empathize with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of understanding may stem from bidirectional differences in communication style, social-cognitive characteristics, and experiences between autistic and non-autistic individuals, but not necessarily an inherent deficiency. Recent studies have shown that most autistic individuals are able to socialize, communicate effectively, empathize well or build good rapport, and display social reciprocity with most other autistic individuals. This theory and subsequent findings challenge the commonly held belief that the social skills of autistic individuals are inherently and universally impaired, as well as the theory of "mind-blindness" proposed by prominent autism researcher Simon Baron-Cohen in the mid-1990s, which suggested that empathy and theory of mind are universally impaired in autistic individuals.
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