Fisher, N. and Happè, F. (2005). A training study of theory of mind and executive function in children with Autistic Spectrum Disorders. Journal of Autism and Developmental Disorders. 35 (6): 757-771.

This article presents the findings of a research study on the effects of attempting to teach theory of mind and executive functioning to children on the Autism Spectrum. Theory of mind is considered to be the ability to understand that others have thoughts, beliefs, or feelings different from one's own, and executive functioning is considered to include the ability to implement goals effectively while keeping up with other demands and being able to tease out which of the demands are more important. Both theory of mind and executive functioning are thought to be impaired in many individuals with Autism Spectrum Disorders. The results indicated statistically significant improvement in theory of mind when children were trained in theory of mind, and no statistically significant improvement in executive functioning after training in that, but surprisingly training for executive functioning alone seemed to improve the participant's capacity for theory of mind.

It is important to note that most of the improvements that the study documents occurred in the clinical tests, and that the children's teachers, when surveyed, observed only minimal improvement, if any. The authors say they did not expect substantial improvements in the classroom setting after such a short training, which is certainly a reasonable explanation (and all the more reason that an in-depth curriculum for teaching these necessary skills, and scientifically valid research to assess how well it works, are needed). There was also some issue with a number of the teachers dropping off - failing to cooperate in returning the questionnaires as the study went on.
The number of participants was relatively small (twenty-seven) and there was quite a wide age range (six to fifteen years old) so, as the authors themselves acknowledge, research with more participants is needed.

However, testing before and after intervention insured that real, comparable progress was being tracked, and following up two months later demonstrated concern for whether the new skills lasted over time - though longer-range follow-up would certainly be helpful. The use of a control group was scientifically crucial (although as the authors themselves point out, the control group should have ideally been given some sort of presumably irrelevant intervention, to test for the placebo effect). And attempting to assess the participants' performance in natural settings (i.e. school) shows good faith on the part of the researchers in wanting to create research that can be applied to reality - disappointing though it may be that the positive effects measured occurred predominantly in the clinical setting on tests designed by the researchers, not in the children's own environments in areas that consistent figures in their lives (such as teachers) found helpful.

The authors propose different explanations for why their research team was not able to train for executive functioning as successfully as theory of mind, and it is also important to note that executive function is a much more complex process than theory of mind and even broader than the components of it the researchers were examining. But another possible explanation is that the theory of mind method used in the study is based on peer-reviewed literature (Swettenham, et al, 1996, as cited in Fisher and Happè), while no source is cited for the executive function model used. Presumably, the authors' literature review did not come up with any validated, evidence-based methods of improving executive functioning in individuals on the Autism Spectrum - which is not surprising - and so they had to "make do." In fact, even though they were able to find research on theory of mind training, there is by no means enough of it to constitute a universal consensus as to best practices. Unfortunately, solid, evidence-based approaches to both executive function and theory of mind are really needed to test for a relationship between the two concepts. Without such approaches being available, this study can only offer preliminary evidence of a connection.

- John Cavanagh

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