Theory of Mind (ToM) is explained as the ability to interpret another person’s words and actions and, thus, to predict what the other person is thinking. The concepts of ToM and its converse, mindblindness, were presented by Simon Baron-Cohen in a publication entitled Mindblindness: An Essay on Autism and Theory of Mind (1997). The theory continues to be used as an explanation of challenges some autistic children and adults experience. However, more recent scholars have presented ToM and mindblindness as a double-empathy problem – a challenge both autistic people and non-autistic people have.

Here are some of the ideas behind ToM and mindblindess – and I offer my own experiences, as a colleague of autistic adults and a coach to autistic employees, as to how a lack of ToM plays out in practice.

Our understanding of autism and theory of mind

In the late 1980s the Theory of Mind hypothesis was presented as a function of neurotypically developing children and a deficit in autistic children. ToM helps children identify deception in others, develop self-consciousness and empathy, and to use persuasion to achieve what they want or need, and it was theorised autistic children lacked those skills. 

We have now learned that in the case of empathy autistic children and adults can be extremely empathetic. A distinction has been made between cognitive empathy and affective empathy. Autistic people have affective (emotional) empathy even if they might have limited cognitive empathy. In other words, autistic children and adults can pick up the emotions of others and empathise with those, even though they might not be able to interpret facial expressions or body language. Therefore, they might not be able to predict what a non-autistic person is thinking or what their intentions might be; however, they can know how they are feeling.

We have now also learned that empathy is a two-way street. Just as autistic children and adults might not be able to predict the thinking and intentions of non-autistic individuals, the converse is also true. Non-autistic children and adults cannot predict the thinking and intentions of autistic individuals. This is called the double-empathy problem.

Another aspect of ToM is the ‘knowing’ aspect. Once an autistic child knows something they cannot ‘unknow it’. In addition, they then expect others to know it too. This has been studied and shown with the Sally-Anne psychological test. In this test a child is asked to work out whether a person outside a room would know what has happened in the room if they cannot see it happening. Children lacking in ToM, when they see what happens in the room, will guess that the person outside the room will also know what happened in the room. If they know it, they expect everyone else to know it.

In my experience as a coach, this aspect of lack of ToM or Mindblindness is the aspect which causes many misunderstandings and confusion.

Autism and Theory of Mind in practice

Two phrases which come up time and again in my conversations with autistic people are ‘You/They should know,’ and ‘I should know”.

• The Playground – they should know. An autistic colleague and friend of mine has an autistic daughter, Jemma (not their real name). At school during one of the breaks, Jemma started to feel overwhelmed and took herself away to a corner of the playground. Jemma’s friends did not want her to be alone and did not want her to feel excluded, so they went to her to encourage her to go and play with them. Jemma became furious with her friends. She knew she was feeling overwhelmed and needed to be alone, so she expected her friends to know that too.
• The workplace – I should know. A coaching client of mine, Ricky (not their real name) started a new job in a large organisation. Ricky had a department boss and half a dozen colleagues. During one of our sessions, Ricky was quite distressed. One of the department systems had not been explained to him, and he did not know what he was supposed to be doing. He felt he was letting the department down by not doing the job properly. When I asked Ricky why he did not ask his boss or one of his colleagues to explain, he said that everyone else knew what to do so he should have known too. His expectation of knowing stopped him from asking for help.

These illustrations present a practical challenge which autistic children and adults experience. Quite often they can feel confused, however they do not articulate the confusion, and they do not ask for help. Either they expect the other person/s to know what they are thinking, so they do not ask; or they feel it is their fault for not knowing, so they feel bad asking. For anyone supporting an autistic individual, whether it be a parent, professional, colleague or manager this perceived lack of communication causes confusion as well.

It is my belief that one way to improve communication between autistic and non-autistic people is to help them understand how ToM works in practice. Explaining why the misunderstandings could be arising, will help the autistic individuals to ask when they need help or support and will help the non-autistic person to be specific with instructions, expectations, and clarifications.

An added challenge is communication with non-verbal autistic people; the ToM and Mindblindness could be as challenging as for those who are verbal. Therefore, the most suitable communication tools must be found to encourage asking for help and more effective communication.

Suggestions for Theory of Mind communication

To help overcome ToM miscommunications and misunderstandings, I offer you my own go-to strategy – ALNA – Always Listen Never Assume. Both autistic people and non-autistic people make assumptions of each other. Both think they have interpreted verbal and non-verbal language correctly. This is seldom the case.

Autistic people are better at interpreting the social cues of non-autistic people than the other way round. This is because autistic people are in the minority, only around 1.7% of the population (CDC 2018) and spend a lot more time practising to communicate with non-autistic people. Non-autistic people do not have as many opportunities.

We are able to learn more about autistic thinking thanks to more media representation of shows such as The ‘A’ Word, The Good Doctor, Atypical and Julia in Sesame Street. Engaging with autistic people in their subjects of interest is another way of learning to understand autistic thinking.

For autistic individuals, some useful strategies for developing ToM (Morris-Clarke 2020) include:

• Turn-taking games
• Talking about emotions
• Social Stories
  
• Comic Strip Conversations
  
• Guessing games

Conclusion

Theory of Mind is the ability to interpret other people’s words and actions in order to predict their thinking and behaviours. Lack of Theory of Mind, or Mindblindness, can make it difficult to make these predictions. This causes misunderstandings and confusion. 

It is difficult for autistic individuals to interpret the words and actions of non-autistic people; however, it is also true that non-autistic individuals have the same difficulties in predicting the intentions of autistic people – the double-empathy problem.

To reduce miscommunication, we all need to learn to question and use strategies to learn from each other: ALNA.

Manar Matusiak is the managing director of Living Autism.