Theory of Mind

Maude Le Roux returns this week to discuss Theory of Mind: what it is, why it’s important, and how to foster its development in our children with developmental differences. Maude is an occupational therapist who runs a DIR clinic called A Total Approach in Glen Mills, PA and she is also a DIR Expert Training Leader who presents around the world on DIR/Floortime and other topics that she has advanced credentials in.

Theory of Mind with Maude Le Roux

by Affect Autism

What is Theory of Mind?

Theory of Mind is the ability of my mind to interact with what I’m getting from your mind, then flexing my mind to what your mind is thinking and feeling. We want to ask ourselves, “Can your child assess your emotional state?” That can easily become a cognitive activity: “I can see you’re mad.” But can your child negotiate their own emotions/emotional state with an adaptive response because they’ve read your emotional state? That’s the complexity of theory of mind.

It’s easier to test the cognitive part and some tests only do that. The beauty of the Developmental, Individual differences, Relationship-based (DIR) model is that it allows us to test the emotional part. Theory of mind is really and fully grasping that your mind is something different than my own and what you are experiencing, thinking, and feeling can be different from what I am experiencing.

Scenario

I presented Maude with an example of my son hitting dad playfully over a year ago. Dad reacted the way most of us would with an emotionally charged, “Stop! We don’t do that!” Now since Dad is introverted and typically has flat affect most of the time, seeing this emotional response became a goal for our son.

It has become a game where our son will walk up and smack Dada yelling “Aow!” in order to see this reaction from his father. He follows that up with a very playful, “Dada, are you ok? Are you happy, Dada?”

Maude had told us that our son is asking those questions because he wants Dad to participate in the game again, not because he understands that he hurt Dada and understands how Dad might feel. He is not being malicious or hurtful. He just likes to see the reaction, and he is noticing that it has an effect.

Maude had suggested that Dad say “Aow!” with a lot of affect and keep our son in that moment as long as possible, in order to foster our son’s recognition of the effect he’s having on his Dad, but Dad’s not comfortable doing that.

What Dad was comfortable doing was lay on the bed with a sad state on his face for an extended period of time, saying “You hurt me” in a calm, sad voice. This made our son quite uncomfortable and so he continued to hit to try to get a reaction out of Dad. It frustrated him that Dad didn’t get worked up.

Maude featured at Affect Autism

Maude Le Roux’s new Functional Developmental Autism Assessment Protocol

Inspiring relating, communicating, and thinking at different developmental levels

Developmental growth spurts: What to expect

The Building Blocks of Motor Planning with Maude LeRoux

A Closer Look at Impulsivity

Remediation versus Accommodation

Regulation Challenges through the Developmental Capacities

Attention and Executive Function

How Does this Invite Theory of Mind?

Since our son does not yet possess theory of mind where he would emotionally understand that what he does might have a serious effect on another person, he is hitting, poking, or kicking to see the reaction from others. Maude tells us that while he may not have theory of mind yet, he is noticing that his actions do have an effect on others. Recall that we previously discussed how his cause-and-effect play has progressed to the social realm.

We also previously discussed how our kids often need to practice and repeat something to figure it out. Maude says he is experimenting with what happens when he kicks his Dada, hits him, and does it harder or softer. So now what we’re doing to support his development is extending the moment so our son can be aware and can focus on that awareness, feeling what it feels like inside of his body to stay in that uncomfortable moment where Dada reacts differently and acts sad.

In that awareness comes that neurological firing of the brain of, “What do I do now? What do I do with this? Why is Dada doing this?” So now the cause and effect makes him negotiate something different. Challenging him in this way promotes his growth and development. Problem solving plays into this theory of mind piece as well. Maude says it’s important to practice this as a scaffolding ladder into theory of mind. Now he has to negotiate, “Let me try something… Let me try something. I’ll try what I tried before, but it’s not working anymore. Now what?“

“We hang it on a hanger“

Maude uses the term, “We hang it on a hanger” when we put something new out there for the child. He can take it down or not. See if he’s going to be able to figure out a new way to respond. That’s where the complexity starts. That’s what we want to see, Maude says. If you quickly erase the moment (by scolding or directing his behaviour, for example), you can easily move on and he will be relieved of this moment.

The fact that he’s feeling it means that something in there is cooking and that’s what you want to hold because he needs that time: much more extra time to really sit with something (new). Now he has to regulate his own state in that moment. He has to say “My cortisol/adrenaline is coming up. How am I going to solve this without running away or going to a meltdown? How do I get to that threshold?”

At the same time, he is also working on emotional inhibition which is a later executive functioning skill. It’s so far beyond social perspective taking and social problem solving. Last year or so, our son wouldn’t have been able to stay in that moment when Dada changed his response. He would have given up and walked away.

Example

If you go home and tell your partner all about what happened today as you vent and he listens, then he says to you, “By the way I’m going to that game on Saturday“, you say “What? Did you even hear what I said?” He completely mismatched where you are at in that moment. In that moment, you were not held in that moment which causes stress for you.

The risk of not staying in that moment

What happens if instead of staying in that moment we do that typical parent thing of yelling, “Cut it out! Stop it!” or some other form of behavioural discipline. Most of us were raised this way, so it’s second nature to us to react this way when our children hit or kick us. But this is where we could be doing Floortime. But perfect parents don’t exist. We have to forgive ourselves when we do something we feel we shouldn’t have done.

Sometimes it is appropriate to get firm. Maude is not a fan of doing one thing for one specific incident. If we only do one thing we aren’t promoting flexibility. We’re still stuck in “If you do this, then this will happen!” That’s not really what we do in a spontaneous social setting. Sometimes it’s appropriate to say, “Sit down until I tell you to stand up.” It’s also appropriate to hold your child in that awareness. It’s asking your child, “Do you have that interoceptive ability to see what’s on my face right now and relate that to how you are feeling?”

The behavioural discipline works and has worked for many generations with neurotypical kids. For our children who struggle with meeting the developmental milestones the behavioural model is not always understood in the way that the parent is meaning. If the child doesn’t get why he must be sitting when his body is asking him to move, his focus is in a totally different place than the parent. So you have a mismatch which doesn’t help anyone because now the parent is concerned that the child is not doing what they want him to do or that he’s out of control, while the child wants to be in control and how will the two meet?

If parents keep with the behavioural model, they just find they have to do the same thing over and over because it doesn’t have meaning for the child.

Maude Le Roux

To Discipline?

Daniel Siegel talks about the neurobiology of emotion. The right brain is emotional and the left brain is logical. If we use firm motions and words to control a child’s behaviour while our child is already upregulated, we’re trying to connect our emotion through the left brain but the child is only in the right brain in the moment. Is your method of using words really getting through to the child and helping him to down regulate? Are we chasing that ‘why’?

Maude says to decide what’s going to work in this moment, considering the developmental level of the child? If you feel like you’ve messed up by scolding the child, then you go find yourself a space to collect yourself. When you come back you can say “I shouldn’t have said it that way. I’m so mad that you did that, but that’s not how I should have dealt with it.” But if they don’t understand that, show acceptance and hug them.

In that moment when they aren’t understanding you and you’re scolding them, they will only be feeling, “I’m going to lose my mommy, my mommy’s mad, somehow I have something to do with it, and I don’t know what to do.” So first, you have to repair the Relationship. You can do the words later when they’re ready to hear that. The repair tells the child they are safe, and that is what’s so important. Maude recommends Dr. Shanker’s Self-Reg book that discusses the process of ‘learning to speak limbic’ when our children are under stress.

Or to Floortime?

What I Did

I told Maude about our experience at a huge indoor play centre with arcade games, bowling, rock climbing, and big gym blocks, etc. Our son loves when his father covers him up, building a fort around him with the big, soft, gym building blocks. He loves to get up and knock it all down. Our son headed towards there right away but we were on high alert because there were kids building a tower and he would want to knock it down.

Well, we weren’t fast enough and our son ran and knocked down the kids’ castle. The girl building it was so upset and started crying. Dada immediately firmly stated, “That’s it! We’re going!” grabbing his hand and pulling him away, but I said, “Wait! Wait! Wait!” I picked our son up like a baby and carried him over to where the girl was crying next to the collapsed castle and said calmly with great concern, “Oh no! Look what happened! The girl is so sad! She’s crying. She’s soooo upset. She worked so hard to build that tower!”

As I spoke slowly with a comforting tone, I continued, “You didn’t mean to make her sad but she’s so sad!” He was listening to everything I was saying. I think that part of it was going in and some of him was still unaware. He responded, “I knocked it down. I want to build it again!” I squeezed him and asked, “Is there anything you want to say to her?” (rather than directing him about what to say). He said, “Sorry, girl.”

Maude's response

Maude said that I put up the hanger. I put it up and there will come a time when he will be able to take it down and assimilate it. He was trying to compartmentalize it and it didn’t fit, but he knew enough that he had to apologize. It’s that superficial first layer. He is probably understanding the cause and effect, but does he really know why he needs to be sorry? It felt so good crashing it down for him, after all.

In his experience, centralized on himself, that’s the most important thing. We’re taking that sense of self that he has accumulated and trying to turn it to what another person is thinking to invite empathy out. He has cognitive empathy. The girl is sad. But he may not feel it. It’s when you really understand it without talking that the true empathy happens. If I come back from this great vacation then I come in and you don’t look good, I can switch and change that emotion and say “Hey, what’s up?” to reach out, while suppressing my own need to share my excitement of my vacation.

Parents have the most power to create that intersubjective response–getting each other without having to talk. You’re sitting at a dinner party and someone says something and you can look at your partner with that knowing glance and know what each other is thinking. You feel and “get” each other. If anyone can put that message into the child’s mind, it’s the parent. We have this power as parents.

I told Maude that I did spend a good amount of time in the next hour and the next day explaining, “When you’re a little bit bigger you’ll be able to stop yourself when you want to knock down the tower, but you won’t want to make the girl sad.” I was ‘planting the seeds’ for the future of knowing what is socially appropriate. Maude suggests that if you’re going to use words, keep it short. Choose your language well, at the child’s level, and don’t do too much of the logical brain because we’re dealing with emotional pieces here.

The body drives emotion and emotion drives the body. He was in emotional brain in that moment, not in logical brain. He’s still working on that transition to the logical brain. You’re not going to get that emotional piece using a lot of words. You can say, “I know that felt good. The girl was sad. One day you will be able to not do that.” For another child you just might acknowledge what happened saying, “Hmm… so sad… girl was sad… you’re ok.” and then hug the child.

Theory of Mind on the Developmental Ladder

Theory of mind is a very crucial process in differentiating whether child has a diagnosis of Autism Spectrum Disorder or Sensory Processing Disorder, according to Maude. It starts to develop in the fourth functional emotional developmental capacity (FEDC) of the Developmental, Individual differences, Relationship-based (DIR) model. In the fourth FEDC, that awareness is what makes my son emerging. He’s staying and wondering what he’s feeling and wondering. You want that registration. It is an early step towards theory of mind.

Theory of mind is a process that can take a lot of time. The transition from FEDC 3 to 4 is the hard transition developmentally. With the third developmental capacity, you’re still working on that two-way communication, stretching it, using playful obstruction and simplistic problem-solving. Once you get into the fourth capacity you’re looking at abstract thinking, fantasy vs. reality, and early imaginary play. When there’s meaning behind it, that’s where level 4 is so robust. You start to abstract in 4, your ideation comes at 4, and you don’t master 4 until 60% of your ideas come from yourself.

You deepen the plot in the fifth functional emotional developmental capacity (FEDC 5). In the 4th capacity, you have all of this emotion. You have to be able to ideate about what it is you might be feeling in order to respond to that at the fourth capacity. Autistic kids have a phenomenal way of trying to figure out how to get what they want, so the parents think, “Well he is so smart, he should be able to understand” when they get frustrated about inappropriate behaviours.

What he’s smart about is what his own body and needs want. He is looking for who else can be an extension to satisfy his needs. He’ll take you by the hand and get you to open that for him, for instance. It’s still about ‘me’. It’s when we enter the space of letting go of one’s own needs in place of another’s needs that we move into Theory of Mind. We need a moral standard and an internal standard. We get that from how discipline plays out at home. All of these pieces are modelled in the early years of life.

Maude says not tot be afraid if it takes a year, or multiple years for your child to master the fourth capacity. She’s seen it happen over and over. The biggest key is consistency rather than going from one thing to another. You might be working on something for a long time right before you see the developmental jump because children keep processing in the moment and out of the moment. When they go to the next situation, they bring that process with them, and the next situation builds on that. They still might not yet have the skill to show us what they have figured out, but in the meantime the brain is putting it together.

Consistency with flexibility

Be consistent with flexibility–that is, not rigidly responding the same way every time–and think about what each experience is really about for your child. What does it feel like in their body? How are they experiencing what I’m experiencing? Practice. Read stories and make those stories come to life. Buy the figures to make the stories come to life, to help make sense of emotional content. All of this is harnessing that fourth capacity.

You can ask things like “Hmm, I wonder why he’s mad?” which gets at the cognitive part of characters. Keep doing that. But more important is having the moments and doing it in the emotional moment. It’s the moment you have to seize. If the child is going through something tough, we naturally nurture. That’s the moment Maude asks us as parents to hold back a little bit and allow our children to feel it, rather than jumping in with a lot of “You’re ok“. Allow them to feel the pain so they can really understand what happened in that moment. Then you can go in and do your nurturing. Emotions are never really easy to work through.

Maude reminds us that we can react in different ways each time so it doesn’t become a repetitive game. There isn’t an answer. Human behaviour is so grey. When you’re struggling with theory of mind, you are prone to put things into categories in the brain. You can’t put ‘social-emotional’ into a category. That’s why our kids shy away from the experiences. They also have a huge memory of why they are getting so upregulated and not being in control in their own body, and they don’t want to feel that again.

Remain flexible about how you respond. The one thing NOT to do is to focus on the hit. The moment you focus on what the behaviour actually is, it causes anxiety in the child’s system because the hit felt so good to him, in our son’s example of playfully hitting Dada. It’s a complete mismatch, even though we know cognitively it is a big thing. Mom and Dad need to have consistency in how they deal with behaviours, while being different from each other. The standard and the core should be a consistent message.

A huge thank you to Maude Le Roux for always enlightening us on the simplicity of the complexity of child development. If you learned something or liked today’s podcast, please consider sharing it on Facebook or Twitter, and please share your experiences and comments in the Comments section below.

Until next time, here’s to affecting autism through playful interactions!