Theory of mind interventions can be effective in treating autism, although long-term success remains unproven

Abstract

WHAT IS ALREADY KNOWN ON THIS TOPIC? Limited theory of mind (ToM) skills are a key problem for individuals with autism. 1 Interventions targeting ToM abilities are highly prevalent among treatments for autism. 2 However, there is no consensus on the efficacy of these treatments, and a wide variety of outcome measures are used. 2 WHAT DOES THIS PAPER ADD? ▸ This is the first systematic review of interventions for ToM skills in individuals with autism. ▸ The inclusion of interventions on ToM, but also on related domains (eg, emotion recognition) or precursors of ToM (eg, joint attention), and the focus on a wide range of outcome measures provides relevant information for clinical practice. ▸ These is some evidence that ToM can be taught to individuals with autism spectrum disorder (ASD), but little evidence on maintenance and generalisation of ToM skills, or the effects of these skills to other domains of functioning. LIMITATIONS▸ The widely varied outcome measures used in the included papers complicate the comparative analysis of different studies. ▸ Blinding participants and personnel in intervention studies may not always be an option. Rather than emphasising possible performance bias, it would be practical to consider alternatives for this problem. For instance, individual differences approaches in larger samples may highlight both child and clinician features that are related to performance bias. WHAT NEXT IN RESEARCH?▸ The inclusion of long-term intervention effects of ToM treatment, to examine the accumulation of social skills during development.▸ The analysis of individual differences in treatment effects, including child features (eg, subtypes of autism, age, intelligence and gender), and also features of the delivery of the treatment (eg, clinician vs non-expert, participation of parents, individual vs groupbased, duration, use of computers or social media). This approach will improve our understanding of whether, why and for whom these interventions are effective. ▸ The development of a uniform battery of sensitive outcome measures, which allows the direct comparison between outcomes of different effect studies on ToM. Outcomes should include both conceptual abilities (ie, the level of ToM understanding) and practical abilities (ie, the use of ToM skills in daily life, as reflected by parent and teacher questionnaires and standardised observation scales). COULD THESE RESULTS CHANGE YOUR PRACTICES AND WHY?The results change clinical practice because they show that ToM interventions are effective. These results highlight the merit of interventions in older children and early adolescents. However, they also show the poor maintenance and generalisation of skills, which require specific attention in addition to the ToM intervention. REFERENCES 1. Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet 2014;383:896-910. 2. Hoddenbach E, Koot HM, Clifford P, et al. Individual differences in the efficacy of a short theory of mind intervention for children with autism spectrum disorder: a randomized controlled trial. ...

Enactivism, other minds, and mental disorders

“…Since ASD has for several decades been thought to consist in a Theory of Mind deficit, prominent treatment and intervention strategies are generally geared toward helping individuals develop their individual mentalizing capacities, such as their ability to represent themselves and those around them (Begeer 2014). 10 Based on the previous discussion, however, we can now see at least two shortcomings to such approaches.…”

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“…Another definition that has been introduced for this emotion is 'fortune-of-others-emotion' (Ortony, Clore & Collins, 1990 as cited in Shamay-Tsoory, 2008), which along with embarrassment and pride is an emotion experienced in a social 2 According to theory, emotions are differentiated between basic (i.e., happiness, sadness, fear and anger) and secondary (also called complex, social, cognitive or self-conscious), like jealousy, pride, shame, envy, gloating and guilt. Secondary emotions require the ability to put oneself in the place of the other person (Begeer, 2014;Lewis, 2000).…”