Theory of Mind and Intelligence: The Importance of Visual Stimulus in Autism.

Background: Theory of mind (ToM) is the ability to attribute mental states to oneself or to others, as well as to understand that others may have different thoughts, affects and intentions than one’s own. ToM is essential in our daily lives to understand human behavior and social interactions. It is well established that autistic individuals have difficulties judging others’ intentions and emotions in complex social situations due to impairments in ToM. However, most studies that use complex ToM tasks to measure mental state understanding require participants to comprehend verbal stimuli. Although autistic children tend to perform better at non-verbal tasks in general, few studies have investigated the performance of these children on ToM tasks using only non-verbal stimuli.

Objectives: This project investigated (1) whether children with autism (ASD) perform differently than neurotypical (NT) children at a ToM task measuring both moral judgement and faux pas; (2) whether intellectual abilities are associated with the performance on this visual task.

Methods: A novel ToM task was used, based solely on visual stimuli (vignettes for the stories and images for the answers), relating to the comprehension of social relationships. Twenty-eight children (16NT; 12ASD) completed a ToM task by exploring visual stories about moral judgements and faux pas. The task consisted of six moral scenarios, which differed in the nature of the action portrayed by the characters: accidental or intentional. The scores were calculated by adding up the correct answers for each item of the moral judgements and faux pas separately, and together. IQ was measured using the Wechsler abbreviated scale of intelligence.

Results: Both groups were closely matched in age (p=.208) and IQ (p=.196) (Table 1). Autistic children performed as well as the NT children at the ToM task in general (t(26)=-1.048; p=.304). Furthermore, there was no difference between groups in their moral judgement (t(26)=-.517; p=609) and faux pas abilities (t(15.78)=-1.088; p=293). In the autistic group, the performance on the ToM task was not significantly associated with global IQ, verbal IQ, nor performance IQ, all ps > .05. However, in the NT group, task performance was positively and significantly correlated with global IQ (r=.586, p<.05) and performance IQ (r=.568, p<.05).

Conclusions: This study examined the performance differences on a ToM task using visual scenarios related to morality and faux pas between an autistic and NT group. This study also investigated the relationship between performance on the task and intellectual level. The results indicate that autistic and NT children performed equally well on the ToM task when presented visually (no verbal replies were required). Additionally, the intellectual level was associated with the performance on the task in the NT group, but not in the autistic group. These results support the idea that 1) individuals with autism are predominantly visual rather than verbal, and 2) due to this particular cognitive style, autistic children may benefit from having access to visual elements during problem-solving tasks about social situations, regardless of their intellectual level.