Theory of mind, severity of autistic symptoms and parental correlates in children and adolescents with Asperger syndrome

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Abstract

This study addresses the theory of mind (ToM) ability of Asperger's syndrome/high-functioning autism (AS/HFA) children and their parents and the severity of the autistic symptoms. Fifty-three families, each consisting of a mother, father and a child, participated in this study (N = 159). The 53 children in the sample included 25 children diagnosed with AS/HFA and 28 typically developing (TD) children. The Social Attribution Task (SAT) and tests assessing autistic symptoms were used. AS/HFA children had lower scores than TD children on three of the SAT indices (Person, ToM Affective, and Salience). Fathers of AS/HFA children did not have lower scores than fathers of TD children on the SAT task, whereas mothers of AS/HFA children had lower scores on the Person index, a pattern similar to seen in their children, suggesting a possible genetic contribution of mothers to ToM deficit in AS/HFA children.

Introduction

The theory of mind (ToM) model posits that the capacity to conceive of mental phenomena is the basic feature of human social interaction. A deficit to this mechanism has been proposed to be involved in autism in its divergent manifestations (Baron-Cohen, 1995). This article addresses the ToM ability of Asperger's syndrome/high-functioning autism (AS/HFA) children and their parents, the severity of the autistic symptoms, and the relations between these parameters.

Social communication deficits are central to AS/HFA syndrome, though they vary in extent. With regard to actual conversation skills, children with AS/HFA have shown more problems with pragmatic responses and with the emotional content of communication (Blacher et al., 2003). One explanation for the lack of social skills in AS/HFA individuals may be difficulties in integrating affective and cognitive aspects of a situation. There is a tendency of AS/HFA individuals to pay attention to parts of the social situation rather than to the whole (Shamay-Tsoory et al., 2002).

One of the most intriguing questions posed by investigations of autistic individuals is the discrepancy between what they achieve on explicit tasks of social reasoning and what they fail to do in more naturalistic situations (Klin et al., 2003). In order to address this discrepancy, Klin (2000) developed a social cognitive procedure comprising the following components:

  • 1.

    Reducing the confounding potential of the verbal mediation of task presentation by minimizing verbal instructions.

  • 2.

    Reducing explicit definitions of the task and measuring the social elements of the task.

  • 3.

    Using stimuli that can be interpreted at different levels of social cognitive ability, from absence of social attributions to attributions including mental states and interactions.

The paradigm developed by Klin focuses on people's ability to attribute social meaning to ambiguous visual stimuli: geometric shapes that act like people (Klin, 2000).

The common view today is that the autistic spectrum of disorders – including autism (Bailey et al., 1995), Pervasive Developmental Disorder (Szatmari et al., 1998), and Asperger syndrome (Volkmar et al., 1998) – is composed of various clinical entities that have a strong genetic component (Gillberg and Coleman, 2000). Gillberg and Coleman's (2000) family studies have shown that the frequency of autism among siblings of probands with autism is between 2 and 5%, i.e. 20–60 times more frequent than in the general population. Later studies demonstrated again that monozygotic concordance rates exceed the dizygotic concordance rate (Folstein and Rutter, 1977, Ritvo et al., 1985, Steffenburg et al., 1989). Results of later British studies showed 60% concordance for 25 pairs of monozygotic twins and no concordance for 20 pairs of dizygotic twins (Bailey et al., 1995). The researchers concluded that the heritability rate is between 91 and 93%. Furthermore, several studies of multiple-incidence (multiplex) families have demonstrated that the genetic liability for autism may be expressed in some of the non-autistic relatives in a phenotype that is milder but similar to the autistic symptoms (Le Couteur et al., 1996, Bailey et al., 1998). Thus a British family study found that 20% of first-degree relatives were affected with autism or with milder social and or cognitive disorders (Bolton et al., 1994).

To summarize, autism and AS are biologically and genetically based disorders with a strong pattern of impaired social behavior in other family members of the autistic child. The ability to attribute independent mental states to self and others in order to explain and predict behavior (ToM) has been a focus of recent research revealing that autistic children have a deficit in this ability. However, there are few studies testing ToM abilities in family members of autistic children, and little work has been done in assessing the relationships between ToM deficits and the severity of the clinical syndrome of autism.

The present study assessed the ability of AS/HFA children and adolescents and their parents to attribute mental states to animated shapes in order to explain and predict behavior (ToM). Such a study may clarify the role of ToM as a mediating mechanism that has a strong impact on the severity of autistic symptoms. It may also show that ToM functions as a perceptual mechanism which is transmitted genetically and enhances the risk of developing AS or autism. We hypothesized that typically developing children will show better performance on the Social Attribution Task (SAT) compared to AS/HFA children, parents of typically developing children will show better performance on the SAT compared to parents of AS/HFA children, the degree of autistic symptoms will be negatively correlated with SAT indices, and social adaptation will be positively correlated with SAT indices.

Section snippets

Participants

Fifty-three families, each consisting of a mother, father and a child, participated in this study (N = 159). The 53 children in the sample included 25 children diagnosed with autistic spectrum disorder (ASD) and 28 typically developing children.

Social Attribution Task (SAT)

The Social Attribution task (SAT), developed by Klin (2000), measures the ability to make social attributions from an ambiguous visual display. The stimuli are a rectangle, a big triangle, a small triangle and a small circle. The movements of the shapes

Results

The age range of the children was 7–18 years (M = 13.20, S.D. = 2.95); the age range of the fathers was 33–62 years (M = 46.38, S.D. = 5.86); and the age range of the mothers was 33–53 years (M = 42.61, S.D. = 4.90). No significant differences in age were found between the two groups. Table 1 presents means and standard deviations of children's and parents' age.

Table 2 presents the variables of education and income for the mothers and the fathers for both the research group and the control group. No

Discussion

AS/HFA individuals were described in numerous studies as lacking sufficient ToM abilities, thus causing them major social difficulties (Baron-Cohen, 1989, Happe, 1995). This study compared ToM abilities of AS/HFA children and their parents with those of typically developing children and their parents. In our study, AS/HFA children lower scores on three of the SAT indices: Person, ToM Affective, and Salience. The other SAT indices of the AS/HFA group were also numerically lower compared to

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