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Exploring Theory of Mind and social ability among children who use alternative and augmentative communication
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
2010 (English)Conference paper, Abstract (Other academic)
Abstract [en]

Social interaction is a powerful vehicle for learning and imitation, shared attention and empathy are fundamental social skills important for early social and cognitive development (Meltzoff, Kuhl, Movellan, & Sjenowski, 2009). These basic abilities that are seen as fundaments for development and learning are not always easily accessible for individuals with complex communication needs (CCN) because of motor restrictions and limited experience (Falkman, 2003; Sundqvist & Rönnberg, in press). The ability to understand and react to emotions and feelings in oneself and in others (Theory of Mind) is most likely mediated via social interaction (Meltzoff, et al., 2009). The focus of the present study is Theory of Mind (ToM) in a group of children with CCN who use augmentative and alternative communication (AAC).

Three studies analysing different aspects necessary to the development of ToM and components of ToM understanding are described in this paper. The different aspects are a) the analysis of a battery of ToM tests and cognitive tests, b) in-depth analyses of the children’s every-day interaction using Conversational Analysis, and c) analysis of the children’s social network. By applying a combination of theoretical and methodological approaches, a holistic view of ToM was attained.

The first study focused on the attainment of ToM in 14 children, aged 6-13, who used augmentative and alternative communication (AAC). The AAC-group, consisting of 8 boys and 6 girls, was matched at the group level with regards to nonverbal mental age to a comparison group of children without disabilities. A second comparison group that consisted of children with mild learning disabilities and matched nonverbal mental age and chronological age was also included. A test battery covering cognitive and language ability, first and second order ToM understanding, as well as understanding of more advanced ToM was administered (Baron-Cohen, O´Ridordan, Stone, Jones, & Plaisted, 1999; Happe, 1998). The results showed that nonverbal mental age correlated significantly with ToM ability. Contrary to previous research, the AAC-group did not differ significantly from any of the comparison groups on the test results.

            The second study investigated active participation in social interaction of three children with CCN. The children included in this study were Bliss symbol users and the aim was to identify components in the children’s interaction in everyday school situations that manifested themselves as active participation for the children. By using Conversation analysis (Schegloff, 2007) to study the social situations we implemented an inductive approach without preconceived notions about what we might find. Three different settings were analyzed for each child: interaction with a peer, a lecture situation with an adult, and a formalized role-play situation. The study identified practices, which induce active participation of children who uses AAC.  The communication partners’ abilities to follow, share or sometimes inhibit a need to shape communicative projects initiated by the child, were important to active participation and engagement of the child in interaction. When the child is active and engaged there are also many occasions of displayed ToM understanding.

The third study focused on the children’s social network and how it relates to the children’s cognitive and mentalizing abilities (N=14). A necessary prerequisite to be able to make friends, in addition to a mentalizing ability, is an initial connection through a social network of interactions over time is also (Chamberlain, Kasari, Rotheram-Fuller, 2007). It is of importance to have variety of interactional opportunities to be able learn and develop social understanding trough experience. Individuals with CCN, however, experience loneliness to a greater extent than other individuals (Cooper, Balandin, & Trembath, 2009). A Swedish adaptation of the Social Network inventory was used to obtain an overall description of the child’s cognitive and language abilities as well as detailed descriptions of the child’s formal and informal social network (Blackstone & Hunt Berg, 2008/2003). For the purpose of this study the analysis focused on obtaining an estimate of the child’s social network at home and at school. Interviews were conducted with a teacher from the child’s school and with the child’s parents. The child was participating in both interviews. We were interested in how many children vs. adults were present in the child’s network and the relative closeness of these communication partners. The results of the third study showed that the social network of children with CCN were very limited. There were few peers in the children’s social network and very few good friends. An expanding social network is important since it is through experiencing social situations the child will learn the socio-cultural aspects of interactions. Social interactions are a very important pathway for learning in general so having a limited social network can be disadvantageous to the child’s general development (Chamberlain, et al, 2007; Meltzoff et al, 2009). Children who were included in general classes had more acquaintances than children who attended special classes, but there no difference was noted when we compared the number of daily communication partners. There was a significant relationship between aspects of the children’s mentalizing skills and the numbers of peer acquaintances in the child’s social network. It is problematical to speculate in the direction of the correlation. The child might have gained friends because of his or her developed ToM or her or she might have developed ToM while interacting with the peers. A developed theory of mind was, however, not enough to be able to make close friends since only six of the 14 the participating children reported that they had a close friend.

In conclusion, the results of the study showed that non-verbal mental age correlated significantly with ToM tasks. Matched for nonverbal mental age the participants did not significantly differ on ToM from a younger control-group without disabilities. Aspects of ToM were, furthermore, observed in all analysed interaction. Finally, significant correlations between the number of peers in the social network and ToM tasks were present, as well as negative correlation between the cognitive tests and the number of adults in the social network. Examining the results of the ToM test, the expression of ToM in interaction and the social network analysis specific implications for intervention were yielded. It is suggested that the ability to understand ToM is essential and related to the children’s interaction in social situations and thus important to their general learning as well.



Baron-Cohen, S., O´Ridordan, M., Stone, V., Jones, R., & Plaisted, K. (1999). Recognition of

faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 29, 407-418. Retrieved from

Blackstone, S., & Hunt Berg, M. (2008). Social Networks. L. Andersson & H. Carlberg

          (Adapt. & Trans.). Sweden: Grafisk production. (Original work published 2003).

Chamberlain, B., Kasari, C., Rotheram-Fuller, E., (2007). Involvement or isolation? The

          social networks of children with autism in regular classrooms. Journal of autism                developmental disorders, 37, 230–242. doi: 10.1007/s10803-006-0164-4

Cooper, L., Balandin, S., & Trembath, D., (2009). The loneliness experiences of young adults   with cerebral palsy who use alternative and augmentative communication.                      augmentative and alternative communication, 25(3), 154–164            doi:10.1080/07434610903036785

Falkman, K. (2005). Communicating your way to a theory of mind. The development of

          mentalizing skills in children with atypical language development. Doctoral Thesis,

          Göteborg, Sweden. Göteborg University, Department of Psychology.  Retrieved from

Happé, F. (1994). An advanced test of theory of mind: Understanding of story characters’

thoughts and feeling by able autistic, mentally handicapped, and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129-154.

Sundqvist, A., & Rönnberg, J. (in press). Advanced theory of mind in children using                 augmentative and alternative communication. Journal of communication disorders quarterly.

Schegloff, E. (2007). Sequence organization in interaction. A primer in conversation analysis. Cambridge : Cambridge University Press.

Meltzoff, A., Kuhl, P., Movellan, J., & Sjenowski, J.S (2009). Foundations for a New Science  of Learning. Science, 325, 284-288. doi: 10.1126/science. 1175626






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URN: urn:nbn:se:liu:diva-88061OAI: diva2:601453
14th Biennal Conference of the International Society for Augmentative and Alternative ISAAC 2010, Barcelona, July 26th -29th 2010
Available from: 2013-01-29 Created: 2013-01-29 Last updated: 2013-04-09

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