
One of the brain detectives at Kids BRAIN, Dr. Marivelisse Rodriguez-Rivera, has spent much of the last year building an intervention program for children and teens on the autism spectrum. Our role, as a team, is to work with children to explore what their brains can do, including their natural talents and assests, and possible areas of difficulty that serve as obstacles for them. We then work with parents to design an intervention plan for that child so that we can leverage their assest and support any deficits that may be there. We work closely with other kid providers in the area, which allows us to directly recommend trusted providers that are experts in their piece of the puzzle and can jump in help. However, there are some deficits that are harder to find supports for. We work with a number of excellent speech therapists, psychologists, and behavioral specialists who offer social skills sessions and groups. However, some children truly have a gap in the foundational skills that allow you to participate in their type of intervention, leaving them in “intervention limbo” while we try to find a good source of assistance. As a team, we have been regularly frustrated that we assess and identify gaps in a child’s skillset in social thinking, but often don’t have resources to recommend to parents to build the specific foundational capabilities needed to be a strong social thinker after that. What’s the point of exploring a child’s strength sets, needs, and future goals (which we do as a team daily with our Kids BRAIN kids) if you can’t then help them overcome their obstacles? As a result, Dr. Rodriguez-Rivera created a program to work on these foundational social thinking functions herself. Needs must. So, this blog post is to help give you more information about what is often an area of struggle for children, especially those on the autism spectrum, and how Dr. Rodriguez-Rivera’s program (which we are calling Training ToM for now, but may make fancier later) can help.
Children and adolescents on the autism spectrum are as different and unique as they can be. However, they are diagnosed with an autism spectrum disorder as a result of a cluster of skill set deficits that impact their ability to grow, develop, and enter the adult world independently in somewhat predictable ways. One of these characteristics is a weakness in social perception. This is directly related to a lack of development of functional skills called “theory of mind” (ToM). This is defined as the ability to understand and take into account another individual’s mental state or of “mind-reading”. In essence, this is the ability to understand that a child’s mind, thoughts, and experiences are separate and distinct from others and that in return, others have experiences, memories, beliefs, and opinions that are different from their own. These differences in mind may not be “knowable” directly at times (I can’t know what you had for breakfast for certain if I wasn’t there and you don’t tell me), but can be guessed at through an understanding of thinking, feeling, and how behavior is linked with both of these (I may be able to use clues about what your food preferences are and things I can observe to make a good guess). Developmentally, this emerges very early on.
During infancy and early childhood, children learn the early skills that they’ll need to develop their theory of mind later on. These skills include the ability to:
- pay attention to people and copy them (using mimickery and pretend play to build new skills)
- recognize others’ emotions and use words to express them (basic labeling of emotions and their different forms)
- know that they are different from other people and have different likes/dislikes from others (establishment of personal preferences and understanding that others have different favorites and dislikes)
- know that people act according to the things they want (knowledge that your behavior gives others information about what you may be thinking and feelings)
- understand the causes and consequences of emotions (building knowledge that certain circumstances or behaviors that you engage in can lead to emotional responses and predictable behaviors in others)
- pretend to be someone else (like a doctor or a cashier) when they play
Part of the process of assessing for possible autism spectrum disorders is to look at these skills directly through play. This is why high-quality autism evaluation involves a psychologist (or other trained assessment specialist) using toys, games, and play-based interactions to determine if early skills in these areas are functional and being developed as expected.
Between 4 and 5 years of age, children start to think more consistently and accurately about others’ thoughts and feelings. This is when true ToM emerges. Children develop theory of mind skills in the following order:
- Understanding “wanting” – Different people want different things, and to get what they want, people act in different ways.
- Understanding “thinking” – Different people have different, but potentially true, beliefs about the same thing. People’s actions are based on what they think is going to happen (the ability to predict outcomes).
- Understanding that “seeing leads to knowing” – If you haven’t seen something, you don’t necessarily know about it (like the breakfast example). If someone hasn’t seen something, they will need extra information to understand.
- Understanding “false beliefs” – Sometimes people believe things that are not true, and they act according to their beliefs, not according to what is really true.
- Understanding “hidden feelings” – People can feel a different emotion from the one they display (that your internal feelings may be different from your outward body language and words).
Children’s theory of mind continues to develop after age five (when a child’s brain is neurologically able to do so effectively; those with autism spectrum disorders have different neural wiring that makes this harder and slower). For the next several years, neurotypical children learn to predict what one person thinks or feels about what another person is thinking or feeling based on what they see, know, their beliefs, knowledge of false beliefs, and their understanding of feelings. They also begin to understand complex language that relies on ToM, such as pragmatic (social) language domains like the use and understanding of lies, sarcasm, and figurative language (like “it’s raining cats and dogs” or “the dog ate my homework”). Some experts argue that ToM development continues through childhood, adolescence, and adulthood as a person has more opportunities to experience people and their behavior.
Closely connected to the existence of ToM is the capacity to distinguish between reliable from unreliable information and the formation of trust in both other people and information that a child is given. This includes being able to recognize a threat and then “downgrade” their response given their observations and further evidence related to false information (“false alarms”). Children under 4 years of age (when they are neurotypical) can discriminate between reliable and unreliable information from a person (detect deception).
When our Kids BRAIN kids on the autism spectrum need help, it is often to guide them in the development of these ToM functions. The new program that Dr. Rodriguez-Rivera has developed is offered exclusively at Kids BRAIN. It includes several modules, which are offered sequentially. Each module builds on the last one, creating new skillsets for these children in a more sophisticated way over time. In order to do so well (because this takes lots of practice!), parents are offered additional support to guide their children in practicing skills. This summer (May-June 2022), Dr. Rodriguez-Rivera will be offering the inaugural course for Module B of the Training ToM program. Deficits in ToM can be highly variable and are not necessarily age-dependent. This means that children and adolescents of all ages will have different levels of skill and will need to enter the Training ToM program at different modules. There is an initial (brief) assessment to “level” their existing skills before starting the Training ToM program. This may mean that a 7 year old enters the program at Module D and that a 15 year old may need to start at Module B. There are multiple entry points because our Kids BRAIN kids each have different strengths, weaknesses, and needs.
For this introductory group, Dr. Rodriguez-Rivera will be looking for a few Kids BRAIN kids to enter at Module B. We will be starting our search with children age 7 and up who “level” at Module B in their initial assessment. Kids that would be an excellent match for this first session would have a diagnosis of an autism spectrum disorder and with the verbal skills sufficient to allow them to answer questions on a variety of topics with an accurate answer. Please reach out to the team at Kids BRAIN if you are interested in this program! Training ToM interest form here: https://forms.gle/7yfaBpbphfjNFkEh8
