Understanding advanced theory of mind and empathy in high-functioning adults with autism spectrum disorder

Abstract

It has been argued that higher functioning individuals with autism spectrum disorders (ASDs) have specific deficits in advanced but not simple theory of mind (ToM), yet the questionable ecological validity of some tasks reduces the strength of this assumption. The present study employed The Awareness of Social Inference Test (TASIT), which uses video vignettes to assess comprehension of subtle conversational inferences (sarcasm, lies/deception). Given the proposed relationships between advanced ToM and cognitive and affective empathy, these associations were also investigated. As expected, the high-functioning adults with ASDs demonstrated specific deficits in comprehending the beliefs, intentions, and meaning of nonliteral expressions. They also had significantly lower cognitive and affective empathy. Cognitive empathy was related to ToM and group membership whereas affective empathy was only related to group membership.

Keywords:

• Autism
• Asperger's
• Theory of mind
• Sarcasm
• Empathy
• Ecological validity

Notes

¹Recent changes to diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM–5) have removed the distinction between autism and Asperger's (American Psychiatric Association, APA, 2013); therefore, for the purposes of the present study, these individuals are referred to as high-functioning individuals with ASDs.

D.M. is supported by an Australian Postgraduate Award (APA). J.A.R. is supported by an Australian National Health and Medical Research Council (NHMRC) Postdoctoral Fellowship (Clinical Training; APP1013796). This research was funded by the Australian National Health and Medical Research Council (NHMRC). We would like to thank the individuals who gave their time to participate in this study and the clinicians who assisted with participant recruitment.

²Australia's largest not-for-profit provider of services related to ASDs, including access to information, support groups, blogs, research participation, and relevant media releases.

³Given the suggestion that reward incentives may improve task performance (Kohls, Peltzer, Herpertz-Dahlmann, & Konrad, 2009), an additional aim of the present study was to investigate the influence of monetary reward on ToM performance in ASDs. However, as there were no significant main effects of monetary reward or significant Group × Monetary Reward interaction effects for any of the analyses, data were collapsed across conditions, and no further investigations into the effects of monetary reward were investigated. These null effects may have been due to the relatively small amount of potential reward (up to an additional $12.50 across the entire task).

⁴Analyses were run separately both with and without these participants. There were no significant differences in the direction or significance of effects, and so these participants were retained in the final analyses in order to preserve power and the high number of clinical participants.

⁵While the overall main effect in both the ASD and control group of poorer comprehension for sincere versus sarcastic interactions appears counterintuitive, it is consistent with the norms for TASIT (McDonald et al., 2006; McDonald & Flanagan, 2004; McDonald et al., 2004). Possible reasons for this effect may be that the sarcastic interactions are more obvious than the sincere, or that the presence of sarcastic interactions primes individuals to (mis)interpret the sincere interactions as sarcastic. Importantly though, there were no group differences in comprehension of sincere interactions, highlighting specific deficits in comprehension of nonliteral expressions in ASDs.