Friday, June 30, 2006

Is The Bear Exhibiting 'Theory of Mind'?

The other day, the Bear, Momma Bear and I were watching a video together – Baby Einstein’s Baby da Vinci™. In one scene there is an owl, located in front of some trees, who hoots a couple of times. A second owl comes up within the trees, unseen by the first owl. The second owl hoots, and then ducks and hides, while the first owl turns towards the sound, looking for its source. The second owl appears in a different location - again unseen by the first owl - watches the first owl for a couple of seconds, and hoot and hides again. This occurs a third time, and then while the first owl is looking in the last place he heard the hoot, the second owl 'walks' up behind him, taps him on the shoulder, and they both giggle. Fade to black.

The Bear thinks this is absolutely hysterical. She giggles away, gets excited, flaps, climbs up on the table we put in front of the TV to keep her from sitting too close to the screen (sigh), giggles and flaps again, and then climbs down and walks over to Momma Bear or myself to either pull our hand or even hand us the remote to rewind the scene so that she can see the whole thing again. This is repeated over and over until she tires of it.

A subsequent scene involves two hippos. The first hippo yawns. The second hippo begins a yawn, and appears to produce a noise like an elephant’s trumpeting. Both hippos are startled. Again the first hippo yawns. The second hippo yawns, with the same elephant sound as a result, and the same sense of surprise. Then the second hippo yawns first, and yawns normally. The first hippo yawns and produces the same elephant sound. Both hippos look at each other, shake their heads, and walk away. Once they are gone, up pops an elephant, giggling and trumpeting away, pleased with its joke. Fade to black.

In this example too the Bear cracks up, and while she is not as insistent on getting us to rewind this segment to watch it again, we end up repeating the scene a few times.

I’ve also described in a previous post an example of playing peek-a-boo with the Bear, in which she clearly outsmarted me (not that you have to get up too early in the morning to accomplish this) by turning the tables and sneaking up on me.

It struck me that the common thread between these three occasions was that the Bear was able to understand the difference in perception between the various characters (in the latter case the characters being the Bear and me), i.e. that each saw the world differently, and drew humour from the differences in perception. Then it occurred to me, are these not demonstrations of Theory of Mind?

From Wikipedia, Theory of Mind is generally described as:

“a specific cognitive capacity: the ability to understand that others have beliefs, desires and intentions that are different from one's own.”


“This theory of mind covers two separate concepts:
1. Gaining the understanding that others also have minds, with different and separate beliefs, desires, mental states, and intentions
2. Being able to form operational hypotheses (theories), or mental models, with a degree of accuracy, as to what those beliefs, desires, mental states, and intentions are.“

The Bear has very recently turned three (Happy Birthday Bear!), so I should not be surprised if she did not yet demonstrate Theory of Mind.

A common ToM test is the Sally-Ann test:

"The experimenter uses two dolls, "Sally" and "Anne." Sally has a basket; Anne has a box. Experimenters show their subjects (usually children) a simple skit, in which Sally puts a marble in her basket and then leaves the scene. While Sally is away, Anne takes the marble out of Sally's basket and puts it into her box. Sally then returns and the children are asked where they think she will look for her marble. A child is said to "pass" the test if he realizes that Sally will first look inside her basket before realizing that her marble isn't there. This is based upon their developing the notion that she "cannot watch..."

"Normal children under the age of four
(emphasis added), and most autistic children (of all ages), will cheerfully and confidently answer "Anne's box"-- they do not conclude that Sally cannot know that her marble has been moved."

"Children who pass the test (presumably) understand that there are two different sets of beliefs:
• their own beliefs, based on what they have personally seen, heard, remembered, imagined, reasoned, etc., and
• the beliefs of others, based on what they have seen, heard, etc.."

Those who fail the test are said by some psychologists to lack a ‘theory of other people’s minds’, although there are problems with the test (discussed in the link) that may call this interpretation into question.

In the three examples above, does the Bear exhibit an understanding that the various characters see the world differently?

In the owl example, while she has a clear sense of excitement and anticipation, she does not react when the first owl hoots. She also does not react when the second owl repeatedly appears. It is only when the second owl hoots and hides that she really starts to laugh, suggesting – to me at least - that she clearly understands that the joke is the deception of the first owl by the second owl. She is also amused when the joke is revealed, but not as much as when the prank is being executed. To understand this scene, I’d suggest that she has to understand that the first owl has a different perception of the world than either the second owl or the viewer.

In the second example, she gets excited when the hippos appear to produce the elephant sound, and when the elephant appears, but she does not appear to have a particularly strong reaction when the elephant trumpets triumphantly (i.e. I don't think it is the elephant trumpet itself that she is reacting to). This example is a more open to question, in that she may be reacting to the incongruity of the elephant sound emanating from the hippo, but I really think she is getting the joke, that the elephant is deceiving the hippos (to whom the joke is never ultimately revealed) and that therefore the two sets of protagonists see the world quite differently.

In the third example, I’d suggest that the Bear understands that I am visibly ‘sneaking up’ on her, and by surreptitiously sneaking up on me she understands that she and I do not perceive the world in the same way. Otherwise, there would be no point in sneaking up on me because I would know that this is occurring.

So, am I overanalyzing, or is the Bear demonstrating Theory of Mind, based on the notion of ‘cannot watch’ mentioned above? If she is, then this demonstrates that a child diagnostically labeled as ‘autism, at the severe end of the spectrum’ is capable of Theory of Mind, and at a young age. Given that 'normal' children don’t usually pass the Sally-Anne test until four (which may be an issue with the test as much as with their cognitive abilities), this would be an interesting result.

If she is not yet demonstrating Theory of Mind in these examples, I would not interpret this as meaning that she is not capable of this ability and/or would not be capable of demonstrating it in the future. Any issues she, and other autistics, demonstrate in this area could presumably be related to sensory integration issues as much or more than due to cognitive weaknesses. If one has difficulty processing incoming stimuli, especially input from other peoples’ faces, then it stands to reason that the ability to analyze the expressions of others - as cues to their state of mind - may be impacted long before this ability fails at a cognitive hurdle.

Those are my thoughts. I’m interested in hearing yours.

Tuesday, June 13, 2006

Moderate Does Not Mean Neutral

There have been occasional comments on and off from the neurodiversity side that refer negatively to some bloggers and/or commenters as being moderate or neutral. This is the latest one to catch my attention:

Some people don’t believe in “rocking the boat,” they want to give themselves the superficial sheen of “neutrality” and portray themselves as being on the moral high-ground by staking out their imaginary “middle ground.” I think they are part of the problem, myself.

I’m guessing that they are not aimed at me personally – I recognize that my profile is not high enough to gain enough notice (that’s not a lament, just a statement) – but regardless, I thought I’d reply on behalf of at least this one moderate bio-med parent.

So, let’s start with a couple of definitions.

First – Neutral:
1. Not aligned with, supporting, or favoring either side in a war, dispute, or contest.
2. Belonging to neither side in a controversy: on neutral ground.
3. Belonging to neither kind; not one thing or the other.

Second - Moderate:

As an adjective:
1. Being within reasonable limits; not excessive or extreme: a moderate price.
2. Not violent or subject to extremes; mild or calm; temperate: a moderate climate.
3. Opposed to radical or extreme views or measures, especially in politics or religion.

As a noun:

One who holds or champions moderate views or opinions, especially in politics or religion.

So, let’s note the difference: neutral means not aligned with, belonging to neither side in a controversy. Moderate means being within reasonable limits, not subject to extremes. To be clear, moderate does not mean neutral, and I am definitely not neutral.

For the record, I consider myself a moderate bio-med. I draw a distinction between autistic thought and autistic disabilities or ‘issues’. I do not believe that there is anything wrong with autistic thought per se, and I am not seeking to cure my daughter of this type of thought. In this I believe I am in broad agreement with those holding a neurodiversity point of view. For the record, I myself am probably part of the broader autism phenotype (BAP), and share more than a few characteristics with my daughter. These traits, including an ability to see the world a little differently than most, have served me well. The difference between us is that I do not seem to have incurred any significant disability (aside from an occasional social cluelessness) to go along with these traits. But my daughter has, and I am seeking to ‘cure’ her of her communications and sensory integration difficulties, believing that they drive her autistic disabilities. In this I am much closer to the mainstream and ‘cure’ side of the autism debate.

As to etiology, I believe that there is more than one cause for autism, and that autism is probably more than one ‘disorder’. My previous posts demonstrate that I clearly believe that there is an underlying genetic vulnerability, but I also believe that there is evidence that ‘something more’ is often required. In the Bear’s case I believe that the ‘something more’ is likely immune/auto-immune related (these issues are in the family), but I am also open to the possibility that it is environmental (defined broadly). I strongly support research efforts to find the causes of autism, and consider myself in opposition to those who do not support this search.

Having said that, I also oppose poorly conducted science, which I believe does not serve anyone well. Exploring a reasonable hypothesis that does not have mainstream support is not poor science. Exploring hypotheses without using the scientific method and without having the goal of arriving at replicable results that can withstand peer review is poor science. Some on the treatment side have conducted poor science, and I believe that the result has been an overstatement of results and a damaging loss of credibility that may slow the ultimate search for answers. I also think that the ‘all autism = mercury’ approach has hampered other research that may find other causes, and I disagree with those that take this one-size-fits-all approach to autism research.

As for treatment, I am definitely on the bio-med side of the debate. We have tested our daughter, using Ontario government health system labs and the Kennedy Krieger Institute, and have found clear medical and nutritional issues that are obvious to mainstream medicine (and for which our very mainstream pediatrician has referred us to specialists). One of the things I am grateful to Kev for is a statement he wrote in 2005 (and I’m paraphrasing) that if an issue is real then it should be detectable by a reputable mainstream lab. We have followed this approach, and mainstream testing has identified – among other things - serious nutritional issues related in part to absorption deficiencies in my daughter. We have worked to correct these issues, using diet and supplements (under the care of a PhD in nutrition) in dosages that take into account RDA limits, and have been successful in controlling and even eliminating some medical issues. We have also seen increased development in our daughter during this time, but I cannot guarantee that the bio-med treatments are the sole source of this improvement.

We do not chelate our child, and to be honest, the process scares me. For the record, my daughter has some potential heavy metal issues (not mercury) that showed up on a mainstream test (discovered by accident – we were testing for essential minerals and ticked the toxic panel as an afterthought). Our approach has been to monitor this and try to naturally rebuild the Bear's detox system rather than use chelation. But I do not oppose others using chelation as long as they have clearly dealt with other bio-medical issues first, have tested their child and found the presence of heavy metals, and are careful to conduct chelation under qualified and experienced supervision and with regular testing/monitoring performed by reputable labs to ensure that no harm is being done.

I am also on the interventionist side in terms of education. My daughter is in an IBI program five mornings per week. As I posted previously, “The goal of her program is not to get her to ‘pass as NT’ - before she was enrolled, the program head very clearly told us that the IBI program would not make her ‘normal’. Instead, it is to teach her skills that will enable her to better and more independently function in the world. Absolutely no effort is expended to get her to act ‘normal’. Instead, she is developing her gross and fine motor skills (e.g. learning how to walk up and down stairs or turn a doorknob), looking at books, learning to communicate through PECS, etc.”

Further, we don’t use IBI to stop her from stimming, since ” we view her stims as a method of communication, self-orientation, and comfort. Her IBI program feels the same way. Instead of trying to make my daughter look NT, they’re trying to teach her the skills that will help her as a human being, regardless of her neuro-orientation.” And as part of the program, ”IBI taught my daughter the first two stages of PECS, as well as helping her to understand the purpose and value of gesturing to communicate. When she gestures, they follow her lead, and they believe that it is important to encourage this. She can now take someone by the hand and lead them a considerable distance to the object of her desire and then communicate to them what she wants, despite being unable to form a single word. As she learns to discriminate between the PECS cards her communications abilities will improve further. Note that none of this is making her any less autistic, but all of it is enabling her to better interact with those around her, make her needs known, and get them met – including her need to socialize and have fun.”

We also have access to a speech and language program, that we’re currently using to teach the Bear stage three of PECS (discrimination), which she is picking up very quickly. Since she cannot talk, we figure that we need to find her another way to communicate, and through both PECS and gesturing she can usually make herself quite well understood. We also had access to OT services, but this access is petering out now that she is nearly three years old. We do have a couple of follow-up sessions due to the generosity of our OT provider, but would welcome more OT support if we can access it.

As for some of the public issues regarding autism, e.g. demonizing autism, the Autism Speaks video or the murder of Katie McCarron, again I am clearly not neutral. My daughter has every right to the same degree of respect and security of person as anyone else, and I oppose any effort to demean, belittle, disrespect, or threaten her because she is autistic. While I do not condone the use of tragedy to falsely label others or to support ideological goals (sorry, but supporting an interventionist or even cure approach to autism does not equate with condoning or justifying murder, and it is insulting to attempt to make or insinuate this link), I will stand with those who respect my daughter and support her rights, and speak out against those who do not.

So, overall we are firmly on the interventionist side of the autism debate, although moderate in application, and - we believe - respectful of our daughter. We are not intervening to ‘cure’ autism, but to treat and hopefully ameliorate the issues that some believe are co-morbidities and some (including us) suspect are the drivers of autistic disabilities. We firmly believe that if we can achieve this our daughter will still be autistic in thought, part of the BAP, and we have absolutely no issue with this – again, our issue is with autistic disabilities, not autistic thought. If our daughter retains her ‘severe autism’ diagnosis then we will accept that too. Our joy is not the Joy of Autism, but the Joy of the Bear, and she will continue to be our joy regardless of her outcome.

What I find interesting is that moderation (not necessarily my moderation, but moderation in general) seems to be threatening to some. My guess is that moderation is probably a greater threat to the ideological poles than their polar opponents. There is a history of extremes targeting moderates to turn situations into a clear black vs. white, ‘us’ vs. ’them’ issues, eliminating any room for diversity of viewpoints or compromise. It is easy to caricature or ridicule an extremist opponent (e.g. ‘all autism = mercury’ is downright silly), but it is harder to ridicule a moderate interventionist approach backed by replicable medical tests and following a moderate educational approach based on what many would consider common sense. In this, moderates could therefore be considered the greater threat.

I’m not saying that my approach is necessarily correct, or that others should follow it. What I am saying though is that it is a reasonable attempt, backed by mainstream derived evidence, to follow a common sense path to help my daughter grow into the person that she is in the process of becoming, and we have a right to follow it. I’m not saying that everyone has to agree, but I have the right to hold my opinions, they are no threat to anyone else, and they do not make people like me ‘part of the problem’.

I’m not neutral. I’m on the side of the Bear.