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.

 

Autistic Meltdown and Shutdown - 'The Last Straw'

 

"Sam was so unprofessional in today's meeting.  OK, so we forgot to arrange a room that had natural lighting and there were fluorescent bulbs in there.  But why not just ask us to change rooms, politely?  Why the big display of behaviour?"

Autistic people get a lot of this.  Well, either as a response to a seemingly-angry 'meltdown', or as a response to an autistic shutdown, where we can't communicate or process what's happening in that moment.

It's often based on a misunderstanding of the physical differences in autistic brains and how they work, and on a misunderstanding of autistic lives and how very, very difficult they are made, by society.

Let's take a look at what's going on.

I've chosen a particular image for this.  It shows a person trying to carry a huge pile of heavy boxes, which are about to topple over.  

Autistic lives are very much like this.  Which extra 'box'/unexpected undoable event will be added to the teetering pile today, and what will happen?  What will be the last straw, to use an expression?

Let's say that Sam wakes up at 6 am on the day of the meeting.  Sam has had about four hours of sleep, because of other health situations that are common for autistic people.  Far more likely to be in chronic pain, for example. Few medical teams realise this or do what's needed to investigate and offer solutions.

Sam opens the post, and finds something from the Benefits people to tell her that her benefits have been cancelled due a misunderstanding...so now Sam has no money to pay for the future support they need to go to work safely and do a good job.  But maybe they'll be paid again if Sam goes through months of stressful Appeal....

Sam also opens three bills that need paying, realising there's now no money to do this.  The anxiety builds.  Then goes to social media to message a friend - but notes how many hate articles and comments there are about autistic people as 'burdens' and 'diseases' and 'costs' who should all be somehow erased from the earth as soon as possible.  The anxiety builds.

Sam would make breakfast, but can't summon the energy to shower, get into workwear, and make something useful to eat,.  So today's another day when Sam leaves for work whilst hungry.  Perhaps there's time to get something before the meeting?

Sam's train is at 7.45am, enough time to get to work.  Except the train is cancelled, and now Sam might be late, which makes her even more hugely anxious and overwhelmed.  There's no money for a taxi, now.   The next train is sensory hell of packed carriages, perfumes, aftershaves, chattering, jostling.  Nowhere to sit down.

Sam makes it to the meeting room, just in time.  Still hungry.  But, there's no outside light, and the room is lit by intensely flickering fluorescent lighting.  Oh no!

Sam's brain goes into an autistic brain event caused by the overwhelm and the sensory overload.  Sam might say something that seems very loud or rude, and may act in an 'out of character' way. Or she may be suddenly very quiet and seemingly 'rude' in ignoring people. The team are horrified.

Sam has little or no idea what's happening, because they are now in a brain event.  This isn't a planned set of responses. Afterwards, she may be so exhausted and bewildered, and very much in need of kindness.

To take us back to the start,  "Sam was so unprofessional in today's meeting.  OK, so we forgot to arrange a room that had natural lighting and there were fluorescent bulbs in there.  But why not just ask us politely?  Why the big display of difficult behaviour? I hope Sam apologises for their appalling conduct!"

It's not anger.  Or being rude.

But I can understand how people misunderstand autistic brain events.

It's similar in some ways for friends who are diabetic and go into a low-sugar situation, where their behaviour becomes erratic, and they may sound cross and 'unprofessional'.  Or friends who have forms of epilepsy, who may likewise behave erratically during a brain 'electrical storm'. 

It's not a choice.  

What can we do to support an autistic colleague who may occasionally having a really bad day and might sound loud or erratic, or seemingly quiet and unresponsive?

Planning in advance, we can be understanding:

We can get really good training, from autistic people.

We can offer a quieter, sensory-friendlier space for them to work in and recover in, realising how important this is, to avoid brain events.

We can realise that it's not appropriate to expect someone to apologise for something that is totally out of their control. Yes, everyone might also have a day when they are actually cross, and I've yet to meet an autistic person who doesn't apologise for getting genuinely angry for no good reason.  But...apologising for a brain event? It would be like expecting a friend to apologise for having an epilepsy event.

We can reflect together, afterwards, on what we can do differently to help them not be in that awful, exhausting situation again. We can use kind phrasing, to check whether they realised what happened.

We can work towards a world that is kinder to the 1 in 30 fabulous people who is autistic.  Really listening and being compassionate, rather than assuming bad motives.

Thank you for reading.

Autistic People - Where are we in 2025? The Positives and Realities

 

Autism. Here we are, 100 years on from the work of Sukhareva, and 80 years on from the original misunderstandings in the 1940s.  So, what's changed, in research?  Almost everything.

I'm an autistic research consultant and lecturer/trainer, currently semi-retired but just as passionate about improving the lives of autistic people, and getting excellent training in place for healthcare, education and many other settings. My decades of work in this field have led to meeting countless hundreds of autistic people of all kinds, in all kinds of settings – including a lot of work with those who are in mental health wards and forensic settings, as well as those with current high support needs for particular things. I provide up to date research summaries for Clinicians, focusing on autism, learning disability and wider neurodivergence.  I have autistic and disabled family members with a variety of other neurodivergent situations in life, and they are deeply loved.

First and most important, some basics that need saying:

All autistic people are individuals, and the information below is not going to apply to everyone.  That’s true of all human beings.

All autistic people deserve a good quality of life and really good support for the things they may find challenging.  Support that asks them what they need, is ethical, considers their Human Rights, and understands that the world has moved on from the ‘deficit models’ and the bizarre beliefs underlying some Behaviourist approaches.  Their families also need that really good support, training and consideration.

Some autistic people have a very tough time in life, because of all sorts of factors.  Many teams were taught that all ‘behaviour’ was ‘autism’, and not e.g. exhaustion, trauma, sensory pain, and other pain from various health conditions, visual impairment, hearing impairment, unmet communication needs, undiagnosed forms of epilepsy causing erratic behaviour, some support staff being bullies, etc. Very unsurprisingly, this combination of things in autistic lives has led to really bad life quality and a lot of anxiety and depression, etc.  We can do so much better than this, as a society.

We have learned so much in the last years, thanks to the tireless work of autistic people generally, autistic specialists and our allies.

Autistic people and allies are leading autism research and ways forward

Take a look at https://monotropism.org/explanations/  Monotropism theory, explaining so much about autistic focus and about why it’s so hard to switch attention instantly.

Also vital, https://journals.sagepub.com/doi/10.1177/13623613221129123  on Damian Milton’s Double Empathy Theory, another groundbreaking autistic-led theory, challenging the idea that communication differences and autistic ways of showing empathy are ‘deficits’ that are solely the fault of the autistic person in some way.  A total rethink is needed.

Another top favourite is the work by McGreevy & team on how we can enable excellent understanding with autistic people by truly listening to their experiences, and how empathy, caring and collaboration are the proper way forward for an exhausted and traumatised autistic population.  https://journals.sagepub.com/doi/10.1177/00221678241232442

I'm delighted to promote work like https://captapnetwork.wordpress.com/2023/09/19/how-to-talk/  which is a guide on how to talk about autistic people.  It links to a huge amount of research, showing the basis of the excellent advice within it.

Also essential, in my view, the huge and ‘eye-opening’ survey findings from some 11,000 people, of which over 3000 are autistic?  https://autisticnotweird.com/2018survey/   Enjoy. So much that dispels myths about autism.  Loads of categories of questions here, and our answers.  Including those from nonspeaking autistic people, and autistic people with a learning disability.

Want the updated version in 2022 with even more answers from autistic people on all kinds of things?  https://autisticnotweird.com/autismsurvey/

So, what's changed in the last decade, in the world of autism?  Arguably, everything.

The Joys of Autistic Children

Let's start with this lovely thing.  https://link.springer.com/article/10.1007/s10803-021-04890-4

In it, the research team asked 153 families about their autistic children and what they're like.

The results?  Loving, happy, having a zest for life, caring for others, sense of humour.  So many other positives. . 

More joy, from autistic interests and movements

Research on nearly 2000 young autistic individuals, showing that their dedicated interests were a joy to them, rarely interfered with their life, and may lead to useful careers and benefits for them and society.  https://link.springer.com/article/10.1007/s10803-020-04743-6    Amongst the most popular focuses of attention, art, music, animals, reading.  So much for the myths about us all being computer geeks of limited creativity, eh?  Isn't research wonderful.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209251 Meantime, this new research shows that autistic stimming (repetitive behaviour such as flapping or tapping) doesn't stop exploratory learning.  We also know that it helps regulate and calm individuals, and https://link.springer.com/article/10.1007/s11013-018-9590-y  is a lovely paper about the purpose and joy of autistic stimming.  Check those 'behaviour plans'.  Unless a stimming behaviour is causing damage to the person or those around them, why decide to change it?

https://tandfonline.com/doi/full/10.1080/00131911.2019.1566213  is one of a variety of papers explaining that many autistic children use those specialist subjects as a way to learn, to thrive.  They are essential tools for many of us.

https://journals.sagepub.com/doi/10.1177/13623613251364361 a lovely 2025 study of over 100 autistic adults, asking them about their strengths and joys, including 'executive function' strengths, creativity, character strengths, etc.

Less likely to be criminals, it seems from research. But more likely to be victims of crime

Yes, autistic people were generally less likely to be involved in criminal behaviour, it seems from this well respected team and huge study.   https://journals.sagepub.com/doi/10.1177/13623613221081343

https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00203/full  is also useful in terms of autism and crime.  Much more likely to be victims. No more likely to be criminal.

https://link.springer.com/article/10.1007/s10803-019-04119-5  Another autism and crime paper, noting that "A diagnosis of autism was associated with a decreased risk of committing cyber-dependent crime".  Yes, people diagnosed as autistic were less likely to commit cyber-crime.

Integrity, kindness, fairness and autistic people.  Lots of newer work on this, e.g.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945921/   is research showing autistic children play more fairly with other children.

https://www.sciencedirect.com/science/article/pii/S1750946718300722

In this one, the autistic participants (20 Uni students) were less likely to tell lies for their personal gain than the non-autistic students.

https://journals.sagepub.com/doi/10.1177/13623613251385029 

Autistic people shared more fairly and generously, with a wider network of people, not just their close friends and family.  

Using autistic senses to protect others?

https://www.sciencedirect.com/science/article/pii/S0891422218302531 Autistic children demonstrated excellent background-scanning abilities in classroom learning situations, and it did not stop them learning. 

Some would argue that having individuals who are better at scanning the environment rather than just the social situation is useful.  For example, being first to smell escaped gas or forest fires, hear approaching predators, etc is a potential societal advantage.   Do many autistic people need ways to tune out oversensitive senses?  Absolutely they do.  Nevertheless, those senses can save lives. Lots of individual accounts in books, online, etc.  Personal anecdote – in 2018 I was in Hawaii, hours before the volcano erupted.  I could smell the overpowering (for me) stench of the rising gases two hours before anyone else on the entire tour noticed it.  It’s not a scientific sample, but it’s worth bearing in mind when textbooks tell you that autism is a bunch of deficits.

Most autistic people have  a good Theory of Mind

What about Theory of Mind?  (The ability to understand that other people have different thoughts and ideas?).  After all, for decades we've been told that all autistic people lack this. Well, no.  Huge piece of research showing there were seemingly a series of horrible misunderstandings. https://psycnet.apa.org/fulltext/2019-75285-001.html

Autistic people have empathy, but it may look and sound different

https://link.springer.com/article/10.1007/s10803-021-05307-y#Sec18 is a 2021 study showing that the 22 autistic adolescent males showed equal empathy to the nonautistic ones.

https://onlinelibrary.wiley.com/doi/10.1002/aur.3197  is yet another study, this one in 2024, showing autistic people had as much empathy as everyone else.

The large piece of research by Chris Bonnello (2018) linked above also looked at results for those autistic people who also had learning difficulties, or who also were non-speaking:

Autistic people have a good set of social skills…with other autistic people

Meantime, brilliant new research from Crompton & team showing that autistic people genuinely do speak a different social language, and work very well with other autistic people, collaborating and sharing.  The problems happen when there's one autistic person and one non-autistic person trying to collaborate, because both misunderstand one another.  https://salvesen-research.ed.ac.uk/people/edinmind

Here's another, showing that same observation that actually we communicate just fine with one another.  It appears to be a misunderstanding between neurotypes, not a 'deficit' on our part.

https://macsphere.mcmaster.ca/bitstream/11375/25433/2/Salt_Mackenzie_2019April_PhD.pdf

Here's another showing that autistic people communicate well with one another and enjoy one another's company (generalising of course) at https://journals.sagepub.com/doi/abs/10.1177/1362361320924906?journalCode=auta

Another?  Sure.  Here's a big one from 2020. Same findings - autistic people get on fine with each other (generalising).  https://www.frontiersin.org/articles/10.3389/fpsyg.2020.586171/full

Have another:  https://osf.io/preprints/osf/efvbc   Yes, here we are again, with autistic people thriving in each others' company and enjoying their communication together (generalising). 

It makes the info in the current diagnostic lists, and the 'checklists for progress' very problematic, doesn't it.  Most of it is now hopelessly outdated.  Some of it may have done awful damage to autistic lives.

“But we should be curing autism!  What about the Severe Ones? Think of the Cost!”

Nearly all do not want a cure. This was the result from asking a huge number of autistic people who are e.g. non-speaking, or have a learning disability. (Autistic Not Weird website - links above).  Similar views can be found in a lot of other spaces, books, sites and pages.

 Respect individual choice, of course.  But, what on earth do we mean by a cure?  Often what people mean is that they are e.g. in pain, and wish someone would sort that out.  Or, they are lonely and isolated and wish people would care.  Or, they are forced out of education and any prospect of a life without poverty, in a society that enables deeply misleading information and hate materials to appear in the Press on a regular basis.  Or, they have had a life of being told they are a cost, a burden, a negative – and end up feeling that way.   The cost thing annoys me; the underlying cost figures were largely based on asking a group of parents to guess some costs, without also asking them about savings.  It also assumed that all of us sit around on sofas all day, not working, and doing nothing for society, which is about as far from the truth as it’s possible to get.  But that’s a research story for another day, eh.

The whole 'autistic people cost more than others' nonsense was based almost entirely on scaremongering guesswork from a single expensive country who insist on expensive (and hopeless) 'interventions', as it turns out from research, and has done immense damage.  But that is a post for another day.  We have only found about 1 autistic adult out of every 10.  We've no idea whatsoever what they do or do not cost.  For all we know, most could be adding hugely to society in countless ways.  We need to stop the catastrophising.

Autistic people are generally absolutely fabulous and I am delighted to share life with so many and listen deeply to them, learning what can make a big difference in their lives.  I thoroughly recommend that approach.

Meantime, my huge thanks to everyone who is working so hard to make an actual difference to autistic lives, to the benefit of the whole of society.

Thank you for reading.