Theory of Mind, Autistic Children, and the Sally-Anne Test

 

There is an old belief that autistic people lack 'theory of mind'.  In other words, can't understand that others have different beliefs about things, different opinions, different knowledge to us.  The debate is still happening, in academic circles.

One of the tests is the Sally Anne test.  The illustration above shows the principle of it, which is described as...

The researcher uses two dolls, "Sally" and "Anne". 

Sally has a basket;

 Anne has a box. 

The research explains to an autistic child, and demonstrates it using toys etc.
 Sally puts a marble in her basket and then leaves the scene.
While Sally is away and cannot watch, Anne takes the marble out of Sally's basket and puts it into her box.

 Sally then returns.
The autistic child is asked where they think Sally will look for her marble. 

Children are said to "pass" the test if they tell/show the researcher that Sally will probably look inside her basket before realizing that her marble isn't there.

The children are quizzed on this by the researcher.  "Where is the marble really?".  "Where was the marble in the beginning?". 

They're testing whether the children realise that Sally doesn't know where it is, now Ann has moved it out of the basket and into the box.

But, is this what it's testing?

Let's think about this.

Autistic children tend to be more honest, and more focused on social justice.  They are also more dedicated to their hobbies and cherished items, and these have a huge emotional meaning for them. We know this from research.

They've just watched a crime happening.  Anne has nicked the precious, loved marble of Sally, and put it into her box, without permission.  Sally is likely to be devastated and about to enter an autistic brain event as a result.  It's so important to the autistic child to help Sally stay out of that brain event (empathy, theory of mind...).   Keen to help Sally solve the crime quickly and be reunited with her precious item, they point fervently to the box, where it is.  For the autistic child, this is the important thing.  And, Sally will look in the box.  Just not first.  So if asked where Sally will look, they're not wrong in saying 'the box'.  

The researcher is asking them questions during this crime, in spoken words, and expecting spoken-word answers.  In all probability, the autistic child's brain will be in near-panic and there's not a hope in heck of getting a proper answer out of them.  Many such tests are carried out at the end of a long day for the child, in a room that is sensory-hell for them, and which may also interfere with the test results. This should always be factored into any answers.

So, did we test theory of mind?  Arguably, yes, but perhaps not that of the autistic child.  We tested theory of mind & autism knowledge of the researcher, because their assumptions about theory of mind are what's at play here - not potential reality.

This helps demonstrate how autistic culture and neurology can lead to very different answers to those expected.  Individual test results may vary of course - this is to assist thinking, not to say that all autistic children will do the above.

Always, always, ask autistic specialists to help guide test processes, so that we avoid potential errors and can test what we think we're testing.

But my autistic child needs to learn to join in festivities?

I've seen a few parents and carers talking about Christmas festivities and other festivals, and how important it is to them to make their autistic child join in.  Some are accompanied by photos of a screaming child, trying desperately to get away from being sat on the knee of a strange man in a red and white suit, or squashed up next to them.

I'll paraphrase some of the thinking:

"But if we let them get away with not joining in, they will miss out on all the fun!"

"If we don't make them do these things, they will end up being a useless burden to society and in a care home - they have to learn to be like everyone else!"

"They are one of the most Severe autistic children. They can't understand consent and assent anyway, so it's up to us to decide on Santa visits for them."

"Are you saying that I should just let my child not go to the Doctors to get vital healthcare, then?"

It's all very worrying, isn't it.  I'll say this as gently as I can, whilst respecting that this is very difficult for some families and situations because of competing needs:

It's not fun for an autistic child to be forced to endure 'fun' things that leave them distressed.  Not even if it is a family tradition.  It's not needed, and it's not the same as having to work gently and carefully with healthcare professionals to make an urgent medical procedure possible.

Because a child was labelled as 'severe', and does not use spoken words ('mouth words') it does not mean that they have no autonomy.  Their distress, their attempt to get away, is very clearly showing their lack of assent. 

Being given a kind life is not making it more likely that they will end up in care.  It does the exact opposite.  Parents and carers who are able to offer kind alternatives, careful transitions, good explanations and cheerful co-production with their fabulous young person...those are the parents who see their autistic young people thrive and learn.  A child forced into terrifying experiences is only learning fear, and not to trust adults.

Bodily autonomy is also so, so important for all of our autistic young people, wherever humanly possible. They are greatly increased risk of harm from predators, and must not be taught that any stranger can put you on their knee and put their arms round you, and Mummy & Daddy think that's just fine.

AI technology exists.  If you need a photograph of your child in a family photo, and they won't or can't be in that shot, it's a matter of moments to get AI to add them (where appropriate of course).  No need to force them into the shot.

Autistic young people deserve to enjoy family gatherings and festive events, in ways that aren't painful, humiliating, exhausting beyond measure,  or potentially dangerous.  There are many wonderful resources out there that explain how to make such family events ones that everyone can enjoy, with things that truly have meaning for them.  For example the work of Chris Bonnello or that of the team and parents at Autism Central

Wishing all of you a gentle, caring, compassionate, thoughtful and joyful festive season.  One that all the family can cherish.