Theory of Mind (ToM) has been described as "...being able to infer the full range of mental states (beliefs, desires, intentions, imagination, emotions, etc.) that cause action.” In other words, people on the autism spectrum often do not understand that other people don’t necessarily perceive the world the way they do. This “mind blindness” can often interfere with successful interpersonal interactions. Case in point: Recently, it came to my attention that there was a young gentleman with significant ToM deficits who created quite a bit of drama when faced with in-the-moment uncertainty. There are many facets to this story, but suffice it to say that in the multiple problem-solving discussions that followed the initial incident, it was ToM that kept rising to the surface as the most insurmountable of obstacles.
It all started with a stomachache. The young man in question was at his Career Education work placement, and he had a stomachache. He was also feeling dizzy, lightheaded and like he was going to faint in some retellings of the story, but the stomachache was the one consistently reported symptom. This student—let’s call him Brian—was given an assignment at work about which he had some confusion, and proceeded to get himself pretty worked up with anxiety over this confusion and the stomachache. He separated himself from the group he was assigned to, reported back to his job coach at a predetermined location, and was given an alternate assignment in the interest of time. All the while, he knew he had the stomachache. HE knew he was feeling very anxious and dizzy and even a bit overwhelmed. If this individual had typically developing ToM abilities, the next logical step would be to tell his job coach so the job coach would also know and then be able to respond appropriately. In this situation, “appropriately” would have meant notifying the job coach’s supervisor (me) and bringing the student back to school for medical attention via the school nurse. This procedure is so much an ingrained part of the routine that we don’t even have to think about “what-to-do-if …” Thankfully, that is the reality, because Brian did not tell his job coach, or anyone else, that he had a stomachache or was feeling ill in any way.
Brian came to school the next day, and in the context of discussing an unrelated incident with school personnel, made a report that he had been sick at work. He explained, in what was described as a highly-charged emotional state, that he had been sick and his job coach had not done anything. This would be grounds for big trouble in my little corner of the world. If the reality was that his job coach, who is under my management, had failed to report that this or any student was ill on the job, then we would have disciplinary issues to consider. When our students are working in the community, everything we do needs to be above reproach.
Thankfully, my own ToM deficits (and there are some, most assuredly!) do not extend to the point of my making an assumption that my staff knows the procedures as well as I do. Brian’s assumption that his job coach knew and ignored an illness could have negatively impacted the program and the reputation of my staff member. Brian was convinced that his job coach knew that Brian was sick, even though he acknowledged that he did not tell his job coach about the symptoms he’d been experiencing. Others present at the job site concurred that no one knew of the illness. Yet Brian believed that his job coach—as well as his classmates, other teachers, and then family members—were aware of the situation.
When my son was younger, and we ran a home-based ABA/DTT program which progressed to the point of perspective-taking, we taught Theory of Mind with the idea that this was a critical piece of the developmental puzzle we were trying to put together. Even then, though, I don’t think I could have done an adequate job of seeing how far-reaching the consequences could be for deficient ToM skills. When I look back on the series of rather unfortunate events chronicled here, I see clearly how this could have had a disastrous end. I suppose the “moral of the story,” if there needs to be one, is that all of us—on the spectrum or not—need to recognize the importance of thinking before we speak, and recognizing that not everyone knows what we know, even if we think that what we know is obvious.