Limited social awareness, a key characteristic of autism (APA, 2013), may be one factor underlying problems in social relationships. This could be because autistic individuals’ difficulties in appreciating and predicting the mental states of others – ‘theory of mind’ (ToM) (Baron-Cohen, Leslie, & Frith, 1985) – might be related to disagreements within friendships. For example, an inability to understand another’s point of view is likely to lead to difficulties in compromising or reconciling, leading to conflicts both occurring and failing to be resolved. As understanding and responding to the thoughts and emotions of others may have an impact on autistic adolescents’ relationships, difficulties in social awareness are a crucial consideration. Neurotypical teenage girls have been found to be more involved than boys in others’ problems, and to have a stronger caring orientation (Gore, Aseltine Jr, & Colten, 1993). This greater involvement means that girls might be more likely to be aware of, and involved in, relational aggression, as they make more use of it in their friendships. This gendered pattern is likely to also be found in autistic adolescents, as Kothari et al (2013) found that in a community sample, girls with high levels of autistic traits were better at an emotion recognition task than boys with similar levels of autistic traits. While one study found no relationship
between ToM and friendship experiences (Calder et al., 2013), this used a simple measure of false-belief understanding, rather than an enriched measure of social awareness.
Many of these problems with social relationships and social understanding have been thought to stem from underlying ToM difficulties (Baron-Cohen, Leslie, & Frith, 1985). ToM is the understanding that other people can have thoughts, knowledge, and motives that differ from one’s own (and also to reality), and that these impact on their behaviour and interactions with others. Any difficulty in attributing alternative other motives to someone else can result in social difficulties because it becomes harder to understand what other people are doing and why, and harder to predict how they will behave towards you, or how you should behave towards them.
ToM has been shown to be present at lower levels in autistic people in a wide range of studies, using people of all ages and with a variety of measures (Baron-Cohen, 2000; Hughes & Leekam, 2004). The proposition of the original theoretical paper (Baron-Cohen, Leslie, & Frith, 1985) was tested using the ‘Sally-Anne Task’, where the participant watches a story about Sally and Anne, two dolls who are playing with a ball. Having put the ball in a box, Anne leaves the scene. Sally then moves the ball into a basket, and when Anne returns, the participant is asked where Anne will look for the ball. Neurotypical participants from the age of around 3 or 4 tend to respond that she will search in the box, as that is where she last knew it to be. In contrast to this, many autistic people will respond that she will search in the basket, as that is where they know it to be (and where it really is) (Happé, 1994). These ToM difficulties often extend into adulthood, and demonstrate that autistic people are relying on their knowledge rather than ‘putting themselves in the shoes of the other person’. This is obviously a key skill in developing and maintaining social relationships, as understanding what another person is thinking or going through is essential to building rapport and understanding their reactions.
There is some debate as to the validity of false belief tasks (Bloom & German, 2000), as they often rely on linguistic and executive function abilities. Autistic people with good verbal ability have been shown to pass ToM with a high verbal component (Happé, 1994), some work has found that these effects persist even in ToM tasks which do not measure false- belief understanding. For example, difficulties with ToM have also been seen in more advanced tasks such as the ‘Reading the Mind in the Eyes’ test (Baron-Cohen, Jolliffe, Mortimore, & Robertson, 1997), where participants are asked to select which emotion a photo of black-and- white eyes are showing from a set of four. This is considered to be a more advanced test because it uses images of real humans, rather than cartoons or dolls, and because the emotions in the test are relatively complex (such as ‘desire’, ‘disgust’ and ‘tiredness’) (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001). Autistic people are less accurate at this test than neurotypical individuals, suggesting that along with difficulties in assigning motives to others, they may struggle with reading the emotional output of the people they are interacting with. This again makes social relationships more difficult, as understanding the emotional state of the person you are talking to helps to make sense of the meaning of their words, and again allows you to predict what best to say to maintain a positive relationship rather than antagonising them or coming across as insensitive. Anecdotally, many autistic adults report being told that they are ‘too blunt’ or ‘say the wrong thing’ because of this difficulty with reading and responding to emotional states, as they respond to what people are saying literally rather than interpreting it in light of the emotional context (Mitchell, Saltmarsh, & Russell, 1997).
Another common feature thought to be associated with autism is a lower level of social motivation (relative to neurotypical individuals) (Chevallier et al., 2012). Autistic individuals are thought to be fundamentally less interested in other people and in making and maintaining relationships with them. Research with very young babies who have siblings with autism has
shown that those who go on to be diagnosed as autistic themselves are less engaged with faces and face-like images as young as 15 months of age (Klin & Jones, 2008; Sasson, 2006). This topic of research has been extended to children and adults, often using the Social Motivation subscale of the Social Responsiveness Scale (2nd Edition) (SRS-2; Constantino & Gruber, 2002). The SRS-2 is a 65-item questionnaire which asks parents to rate the frequency of behaviours of their child, or adults to rate their own behaviours, over the last six months. These ratings correspond to different subscales of behaviours associated with autism, such as Communication difficulties or Restricted and Repetitive Behaviours and Interests (RRBIs). These studies have found that autistic children are rated as significantly less socially motivated than their neurotypical peers (Chevallier, Kohls, Troiani, Brodkin, & Schultz, 2012) and that autistic adults rate themselves as less socially motivated and more socially impaired than neurotypical adults (Orsmond, Krauss, & Seltzer, 2004). This is not, however, a universal finding. Adult autistic women in particular have reported finding other people fascinating, and desperately wanting to make friends and fit in, despite struggling to do so (Kanfiszer, Davies, & Collins, 2017).
It is worth noting that ToM has recently been shown to be a ‘two-way’ issue, described by autistic scholar, Damian Milton (2012), as the ‘double-empathy problem’, which holds that the apparently instinctive empathy of neurotypical people is not applied when it comes to autistic people. Neurotypical people are less accurate at interpreting the emotions displayed by autistic people (Brewer et al., 2015), and say that they are less likely to want to socialise with autistic people based on brief video exposures (Sasson et al., 2017). This emphasises that difficulties with autistic-neurotypical interactions are not simply due to the autistic person struggling to engage ToM, but that both parties involved may be making mistakes which contribute to an awkward situation overall. That these difficulties are not just due to the autistic person ‘getting it wrong’ is supported by work from Heasman and Gillespie (2017), which
showed that social misunderstandings are often in both directions and with both autistic and neurotypical parties.