On Appearing Autistic: Theory of Mind

Tonight, I was discussing with a nurse an autism support meeting I went to last week. We got to talking about how autistic the participants appeared, and the nurse mentioned that she had a family member who works at one of the country’s largest autism facilities, which happens to be in my town. The nurse talked about how the autistics who go there are much more obviously autistic than I am.

I have been diagnosed with autism by three different diagnosticians in three different evaluations between early 2007 and late 2010. The last two, who did the most extensive evaluations, both had their reservations about the diagnosis. There were roughly two reasons for this: 1. that I appear to have good theory of mind, and 2. that they weren’t sure which of my oddities were due to autism and which were due to blindness or other factors. I want to talk about the first now.

I am pretty sure I mentioned this before, but theory of mind is not the same as prosocial behavior. People who are antisocial, except for maybe the worst of psychopaths, have good theory of mind and use it to their advantage. I honestly have pretty bad theory of mind, to the point where I fail the more compliciated versions of the Sally and Anne test. Theory of mind is the ability to shift your focus from your own cognitions and emotions onto anoother person’s. In the Sally and Anne test, Anne has a toy in her basket. She leaves the room and Sally moves the toy to her own basket. Then Anne returns and the person being assessed is asked to say where Anne would be looking for the toy. The correct answer would be Anne’s own basket because it was here when she left, but people with poor theory of mind who have seen Sally move the toy, will say Anne will look into Sally’s basket. Note that the Sally and Anne test in this version is passed by most typically-developing four-year-olds, and real-life theory of mind is much more complex.

I, for one, appear to have good theory of mind, because I am generally pretty sociable and also because I exhibit a good deal of prosocial behavior. I was told by my former therapist that I had good theory of mind because I apologized in about every E-mail I wrote to her in case she didn’t want to receive E-mails from me. This, however, is not theory of mind. I have no clue when it is and isn’t appropriate to write your therapist out of session and so apologize just in case. Inndeed, when I am rude, I pretty often forget to apologize if I even realize I am rude. Because I don’t talk out of turn and say rude things 99% of the time, doesn’t mean I know when it’s appropriate to talk and what to say.

In addition, I have above-average verbal intelligence, which allows me to reason through social situations pretty well. I used to make my own Social Stories in high school, but still was seen as quite a rude person. Now that I’m in my twenties, I’ve learned to adapt and become less in your face unless I’m agitated. While this could connote a better theory of mind – after all, I can reason through social situations to some extent -, it is not nearly enough for what is required in everyday social interactions.

I at one point read an article by I believe Tony Attwood on Asperger’s in females, in which it was said that Asperger’s is often not recognized in females because male Aspies tend to be active but odd, ie. talking out of turn, talking on and on about one subject, etc. while female Aspies are often passive, ie. only interacting when encouraged to. I reckon that more passive Aspies tend to aslo be more cautious about their social interactions. This could easily lead to them not appearing as Aspie because they aren’t saying inappropriate things.

Please remember that autism is not a behavior disorder. It’s a neurodevelopmental disorder that impacts on various aspects of functioning, theory of mind being just one. Even if a person has relatively good theory of mind, that doesn’t mean they don’t have the processing dyfunction that is thought to cause autism.

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