Autism spectrum disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviors (APA, 2018). The DSM-5 cites social deficits among autistic individuals such as issues with social-emotional reciprocity and difficulties developing, maintaining, and understanding relationships (APA, 2018). When analyzing these difficulties from a cognitive viewpoint, the most common theory for these social-communication struggles involves impairments in the Theory of Mind (Jones, ).
This paper will examine the crucial role of the Theory of Mind in autistic individuals and how it relates to other cognitive processing difficulties and the overall sense of self. Theory of Mind (ToM) is the ability to attribute mental states to others (Jones, ). This includes understanding that others have beliefs, desires, intentions, perspectives, and emotional states separate from one’s own. Simon Baron-Cohen is a well-known autism researcher responsible for the “extreme male brain theory” as well as proposing the theory of “mindblindness.” As part of this latter work, Baron-Cohen stated that children with autism have “massive impairments” in ToM (Richman, ). However, it must be noted that typical ToM tasks require additional cognitive skills such as inhibition and response selection (Jones, ).
The most common way to assess ToM capabilities in children is through the use of “false belief” paradigms. In these assessments children are presented with naïve story characters which they then must reflect on both “first-order” false beliefs, which indicate what children think about real events, and more advanced “second-order” false beliefs, which refer to what children think about other people’s thoughts. The ability to analyze and understand these false-belief scenarios has shown to be crucial for successful social interactions among preschool age children. When tested against their typically developing peers, preschool kids with ASD show deficits in this basic ToM reasoning(Cog, TOM, ). Several studies have yielded these same ToM results and follow-up research supports the idea that ToM is uniquely predictive of specific ASD social symptoms rather than social functioning more broadly (Cog Tom). Even in “High Functioning Autism,” individuals who can correctly respond to false-belief questions are largely unable to generalize these skills in-vivo (TOM Soc).
This is thought to more largely reflect their superior communication ability rather than an increased ToM; consequently, ToM has been shown to be predictive of communication ability and overall ASD symptom severity. In order to successfully relate and empathize with others the individual must have a clear correspondence of the self, and how that relates to the other. In Bird and Vidling’s ‘self to other model of empathy’ (SOME), in order for individuals to understand the emotional state of others, they must first recognize the emotional state and then elicit a corresponding state in oneself. This requires the ability to “self/other switch” between the default ‘self’ state to the ‘other’ via the ToM system (Richman, ).
While historically autism has been seen as a form of egocentrism (stemming from the Greek “autos” meaning “self”), more recently a compromised sense of self has actually been highlighted (Self-Refernecs). Limitations in the ability to relate to others further limits autistic individuals sense of self, as human self-concepts are directly influenced by our experiences with others and how we view ourselves in relationship to “important others.” Self-awareness limitations in ASD appear to be largely psychological in nature rather than physical. For example, children with ASD pass the “mirror-test” milestone at 18-months. Additionally, they are able to recognize themselves in delayed video images and discriminate between change in their direct environment caused by themselves versus changes caused by others. But once again as it relates to their ability to communicate in a way that indicates self-consciousness, children with ASD exhibit higher levels of alexithymia (inability to describe one’s own emotions) and unusual pronoun usage (“I” vs. “you”).
When asked to introspect, or think about themselves, autistic individuals show a preference to speak in generalities, referencing activities or actions rather than self-descriptors (“I like jogging”). Furthermore, when probed, autistic individuals are able to accurately describe themselves physically, but often neglect to include social experiences in their examinations of themselves. Another way in which this a-typical self-concept can be demonstrated is through the “self-reference effect.” According to the self-reference effect, stimuli relating to the self, either implicitly or explicitly, receive enhanced encoding through the episodic memory system compared to stimuli that do not relate to the self. Therefore, words associated with oneself are more easily recalled than those that are not. (“I am clever” vs. “Barbara is clever”).
Similarly, owned objects are typically viewed and processed as extensions of the self, giving them cognitive priority (deeper encoding) and therefore are better remembered than other items that were not. As an extension of self-reference, the “ownership effect” occurs consistently and significantly in typically developing individuals, while it appears to be largely absent in ASD experiment groups. Memory and the self also seem to be inescapably linked with a growing body of research pointing to the self-concept as a pre-requisite for autobiographical memory. Autobiographical memory is the system responsible for a person’s “self-knowledge”, such as an individual’s life experiences (autobiographical episodic memories) and personal information (autobiographical semantic memories). Although memory issues are not included in the DSM-5 criterion for ASD, they have been widely reported among individuals with autism. Specifically, difficulties with autobiographical memories have been noted since the clinical emergence of the disorder (AM, ).
When Leo Kanner published the first scientific paper on autism in 1943 he included information detailing that autistic children frequently failed to recall events from their day and when they did so, they would often leave out portions and/or provide confusing details (AM, ). Furthermore, studies utilizing the autobiographical cueing task have found that adults with ASD generate fewer, less specific autobiographical memories and take significantly longer to do so than the typical-control groups (AM, ). Successful autobiographical memory retrieval depends on autonoetic awareness and the ability to recall events from a first-person point of view. Yet studies have found that adults with ASD often adopt a third-person observer perspective during retrieval, which does not encode for context in the same manner. When participating in remember-know word recognition tasks researchers found that while overall recognition performance was equivalent between adults in both ASD and control groups (of similar age and IQ), autistic individuals depended on noetic “knowing” conscious encoding (without context) while the typical adults relied on autonoetic “remembering” awareness in which they recalled contextual details associated with the word presentation. As with the self-reference effect, the data seem to indicate that the episodic encoding required for optimal autobiographical memory performance is lacking in individuals with ASD.
Since autobiographical memories by definition are always self-referential it logically follows that there is a correlation between the self and autobiographical memory, though few concrete studies exist on the subject. The “self-memory system” theory proposes that autobiographical memories are a necessary and integral part of one’s self-representations. As episodic memories are encoded, organized and updated, so too is the current self-model updated. Additional research suggests that the relationship between memory and the self is cyclical, whereby a fully-functional, dynamic self-concept depends upon the organization and retrieval of personally meaningful events generated by autobiographical memory, yet in order for a person to encode and make sense of these autobiographical memories, a concept of self must be present to analyze and evaluate their content.