If you want you own copy of the study, you will need the reference. It is:
"Another Advanced Test of Theory of Mind: Evidence from Very High Functioning Adults with Autism or Asperger Syndrome." Baron-Cohen, S., Joliffe, T., Mortimer, C. and Robertson, M. Journal of Child Psychology and Psychiatry, Volume 38, No. 7, pages 813-822, 1997
Introduction:
Simon Baron-Cohen
This is a classic study into the effects of autism. Autism is defined as a global developmental disorder. One of the characteristic deficits that many sufferers have is that they do not have a "theory of mind". Put simply, it is the ability to know that somebody else may be thinking about something differently from you. It is thought that not having a theory of mind may underlie the social, communicative and imaginative abnormalities that are diagnostic of the condition. The theory of mind deficit appears to be expressed very early, from at least the end of the first year of life, as joint attention deficits.
However, there is some evidence that appears to contradict the notion that a theory of mind deficit is a pure cognitive deficit in autism. First, Bowler (1992) found that adults with Asperge Syndrome - who share the social and communicative symptoms of autism but who have no history of language delay - pass second-order theory of mind tests. These tests involve the subject reasoning about what one person thinks about another person's thoughts. Ozonoff et al. also found some adults with "high-functioning autism" or Asperger Syndrome who passed second-order theory of mind tests. Both of these contradict an earlier study by Baron-Cohen that there is an impairment in theory of mind in autism.
However, these studies cannot be taken as conclusive evidence for an intact theory of mind in such individuals with autism or Asperger Syndrome, because such second order tests can easily produce ceiling effects if used with subject with a mental age of above 6 years. This is because children with normal intelligence pass second-order theory of mind tasks at about 6 years. It is unfortunate that many workers in this field have though of second-order tests as "complex" or high-level theory of mind. Certainly, they are more complex than the first-order tests (in which the subject has to infer the thoughts of another person) - but recall that normal 4 year old children pass first order tests.
In short, neither first- or second-order test are complex test of theory of mind. They are simply probes for 4- or 6-year-old level skills, respectively, in this domain. Perhaps if they had been labelled as such, no-one would ever have though of them as suitable tests of whether and adult (with autism, Asperger Syndrome, or other condition) has a fully functioning theory of mind. Finding a 30 year old individual with autism, of normal intelligence, who can pass a theory of mind test at the level of a normal 6 year old child does not lead to the conclusion that they are necessarily normal in this domain
Happe's (1994a) study is the only one to take this issue seriously. She tests adults with autism or Asperger Syndrome on an "advanced" theory of mind task. This involved story comprehension, where the key questions in the task either concerned a character's mental states (the experimental condition) or physical events (the control condition). Happe's task was pitched at the level of a normal 8-9-year-old, and in this respect, it is certainly more advanced than previous tests of theory of mind. She found that adults with autism of Asperger Syndrome had more difficulty with the mental state questions than did the matched controls, and that they used fewer appropriate mental state terms in their justification of why characters behaved as they did.
In the present study, we used a new, adult test of theory of mind competence, as another advanced test with which to test high-functioning adults with autism or AS. This extends Happe's line of research. The task involves looking at photographs of the eye region of the faces, and making a forced choice between which of two words best describes what the person (in the photograph) might be thinking or feeling. The task is called the "Reading the Mind in the Eyes" Task or the Eyes Task for short.
Method:
The method used in this study is an Experiment. There are three groups of participants and their performance on the Eyes Task will be compared, (this is the Independent Variable - for further explanation see my Methods page).
Sample:
There were three groups of participants, each group was tested.
GROUP1
This comprised of 16 participants with high-functioning autism (HFA, N=4) or Asperger Syndrome (AS, N=12). The sex ratio was 13:3 (m:f). The HFA group all showed a history of "classical" autism (i.e. autism accompanied by language delay) and fulfilled established diagnostic criteria (American Psychiatric Association, DSM-IV, 1994). The AS group all met the same criteria for autism, but without and clinically significant language delay (i.e. they had single words by age 2 or phrase speech by age 3, as reported by their parents). They thus met the criteria for Asperger Syndrome as defined by ICD-10 (World Health Organisation, 1994). They were all of normal intelligence. As such, they are relatively rare. They can be considered as case of "pure" autism or Asperger Syndrome, unconfounded by mental handicap. They were recruited from a variety of clinical sources, as well as an advert in the National Autistic Society magazine Communication.
GROUP 2
This comprised 50 normal age-matched adults (25 male and 25 female) drawn from the general population of Cambridge (excluding members of the University), all of whom had no history o any psychiatric condition (as established by self report). They were selected randomly from the subject panel held in the University Department. IQ information was not collected on subjects in this group, but they were all assumed to have intelligence in the normal range.
GROUP 3
This comprised 10 adult patients with Tourette Syndrome (TS) also age-matched with Groups 1 & 2. The sex ratio was 8:2 (m:f) thus mirroring the ratio in Group 1. They were attending a tertiary referral centre in London, and had all been diagnosed by a leading expert in the field of Tourette Syndrome, on the basis of meeting DSM-IV criteria for Tourette Syndrome.
The participants in Group 1 were also selected for being of at least normal intelligence, by using an established IQ test. We therefore, ensured that these participants had an IQ of >85 on both verbal and performance scales.
The participants in Group 3 were also tested, and found to have intelligence in the normal range, but used a shorted test than for Group 1, due to time constraints
Finally, subjects in Groups 1 & 3 were selected for being able to pass two first order false belief tasks, and a second-order false belief task. This was so that if any deficits were found in the Eyes Test, they could be attributed to a mind-reading problem beyond a 6-year-old level. In fact, this did not lead to any of the clinical subject being excluded.
Table showing Chronological Age (CA) and IQ of the participants in each of the Groups
CA WAIS-R IQ
Autism/Asperger
Syndrome (N=16)
Mean
SD
Range
​
Normal (N=50)
Mean
SD
Range
​
Tourette Syndrome
N=10
Mean
SD
Range
28.6 105.31
9.7 13.0
18-49 86-133
​
​
30.0
9.12
18-48
​
​
​
27.77 103.5
7.81 10.0
18-47 93-115
Statistical testing in terms of Age and the IQ test revealed no significant differences between the three groups.
Method and Design
​
The Eyes Task, the Strange Stories Task, and the two control tasks were presented in random order to all participants. The tests were administered individually, to each participant, in a quiet room either in their own home, in our clinic, or in our lab. at the University.
​
THE EYES TASK
The test comprises photographs of the eye region of 25 different faces (male and female). The faces were taken from magazine photos. All faces were standardised to one size (15 x 10 cm.) and all were in black and white, with the same region of the face selected for each photo - from midway along the nose to just above the eyebrow. Some examples of what the photos looked like is shown below:
Each picture was shown for 3 seconds, with a forced choice between the two mental state terms printed under each picture. The experimenter says to the participant "Which word best describes what this person is feeling or thinking?" The maximum score on this test is 25.
CONSTRUCTION OF THE EYES TASK
The target word describing the mental state behind each pair of eyes was generated by four judges (two male and two female) in open discussion. A foil word was selected that was the semantic opposite of the target word, in all cases. These were then tested on a panel of eight judges (four male and four female) who were independent raters, blind to the hypothesis of the study. On the target words there was unanimous agreement by all eight independent raters.
​
VALIDITY OF THE EYES TASK
The Eyes Task is designed to be a "pure" theory of mind test, at an advanced level. In order to validate the Eyes Task as a theory of mind task, participants in the two clinical groups were also tested on Happe's Strange Stories. In the case of the subjects with autism and Asperger Syndrome, this was part of a separate study (Joliffe, 1997). If the Eyes Task was indeed tapping theory of mind, then the performance on the Eyes Task should correlate with performance on Happe's Strange Stories.
Below, you will see a list of the words used and their semantic opposite.
TARGET MENTAL STATE TERMS, AND THEIR FOIL TERMS
No. Target Term Foil
1 Concerned Unconcerned
2 Noticing you Ignoring you
3 Attraction Repulsion
4 Relaxed Worried
5 Serious message Playful message
6 Interested Disinterested
7 Friendly Hostile
8 Sad reflection Happy reflection
9 Sad thought Happy thought
10 Certain Uncertain
11 Far away focus Near focus
12 Reflective Unreflective
13 Reflective Unreflective
14 Cautious about Relaxed about
something over something over
there there
15 Noticing someone Noticing you
else
16 Calm Anxious
17 Dominant Submissive
18 Fantasising Noticing
19 Observing Daydreaming
20 Desire for you Desire for someone
else
21 Ignoring you Noticing you
22 Nervous about you Interested in you
23 Flirtatious Disinterested
24 Sympathetic Unsympathetic
25 Decisive Indecisive
​
The item number in this list corresponded to the words used with the photograph in that position.
CONTROL TASKS
Finally, in order to check whether deficits on the Eyes Task were due to other factors, we administered two control tasks to the participants in Group 1.​
Gender Recognition Task. This involved looking at the same sets of eyes in the experimental task, but this time identifying the gender of the person in each photograph. This is a social judgement without involving mind reading, and allowed us to check if any deficits on the Eyes Task could be attributed to general deficits in face perception, perceptual discrimination, or social perception. This had a maximum score of 25, as to be expected.
Basic Emotion Recognition Task (Emotion Task). This involved judging photographs of whole faces displaying the basic emotions (based on the Ekman categories). This was to check whether any deficits on the Eyes Task could be attributed to a deficit in basic emotion expression recognition. Six face were used, showing the basic emotions of: happy, sad, angry, afraid, disgusted and surprised. Note that the Basic Emotion Recognition Task differs from the Eyes Task in two ways:
1. the Emotion Task affords information from the whole face, whereas the Eyes task has information from the eyes alone
2. the Emotion Task test just the basic (six) emotions, whereas the Eyes Task test the full range of mental states.
Results:
To recap, the results that were being collected were the comparison of the different groups on the Eyes Task, and they also collected data from the comparison of "normal" male and female participants on the Eyes Task.
GROUP'S PERFORMANCE ON THE EYES TASK
Eyes Task Gender Control
Autism/Asperger
Syndrome (N=16)
Mean 16.3 24.1
SD 2.9 0.7
Range 13-23 23-25
​
Normal (N=50)
Mean 20.3 23.3
SD 2.63 1.1
Range 16-25 22-25
​
Tourette Syndrome (N=10)
Mean 20.4 23.7
SD 2.63 0.9
Range 16-25 23-25
PERFORMANCE BY MALES AND FEMALES IN THE NORMAL GROUP
Eyes Task Gender Control
Males (N=25)
Mean 18.8 24.0
SD 2.53 0.6
Range 16-22 23-25
​
Females (N=25
Mean 21.8 23.8
SD 1.78 0.6
Range 20-25 23-25
As can be seen from the Results given above, there was no difference in the performance on the Eyes Task by those with Tourette Syndrome and the normal group (combined male and female) (t=0,092, 58df, p> 0.93). However, it can be seen that both the control groups performed significantly better than the autism/Asperger Syndrome group (Autism/AS x Normal t=-5.16,64df, p=0.0001) (Autism/AS x TS, t=-3.98, 24df, p=0.001). In the Normal group, as was predicted, female participants performed significantly better than male participants (t=-4.8, 48df, p=0,0001). The Autism/AS group difference remained significantly different when was compared to the normal males (t=2.93, 39df, p=0.006). Inspection suggested that there was no difference in the performance of those with Autism and those with Asperger Syndrome. However, due to the small sample size, no statistical test was carried out.
It is of interest to look at individual performance. If one assumes that scoring 15/25 or more is better than chance (Binomial Test) then only 8/16 of the Autism/AS group scored above chance, versus 10/10 of the TS group and 50/50 of the Normal group. This is a highly significant difference (chi-square p<.01).
On the Gender and Emotion Control Tasks, there were no differences between the groups. Within the Autism/AS group there was no significant correlation between IQ and performance on the Eyes Task (r=-.08). Finally on Happe's Strange Stories, no participants in the TS group made any errors, but the participants in the Autism/AS group made errors and were significantly impaired on this task compared to the control groups.
Discussion:
At the start of this process of carrying out this study, there were several predictions made. The first was that the Autism/Asperger Syndrome group would struggle on this subtle Theory of Mind test. Also it was predicted that normal females would perform better at the Eyes Task than normal males. Both of these predictions were confirmed by the results of the study.
The impairment of the Autism/AS group was not due to lower than average IQ as all of these participants had IQ in the normal range. In fact, some of the participants in this group had University Degrees but still performed poorly on the Eyes Task. Some suggested that the reason that the Autism/AS group did poorly was that the neurological damage associated with autism or Asperger Syndrome. This may not be the case as those with Tourette Syndrome have been found to have brain damage but managed to perform within the same range as normal on the Eyes Test. The performance on the Eyes Task was mirrored by the performance on the Happe's Strange Stories test. It could be that the performance on the Eyes Task is similar to some of the problems that people with autism have while they are growing up. Young children with autism fail to interpret gaze as a signal for concentration or having interest in something.
The Eyes Task is a very advanced test of Theory of Mind, but it is much simpler than real life. Some of the Autism/AS group mentioned in passing that they find going to the cinema a frustrating experience as they do not understand why a character in the film did or said something, which characters know what pieces of information, or why the audience laughs at certain points during the films.
The differences found between the normal females who di much better on the Eyes Task than normal males. It is true that as female grow up their language skills sometimes a much better than their male contempories. On the other hand, males growing up have much better spatial skills than females. These difference may result from some genetic or socialisation difference they experience while growing up. This may give some clue as to the difference in the performance on the Eyes Task.
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