**3. Explicit theory of mind reasoning in Autism Spectrum Disorders**

#### **3.1. Early explicit ToM in spontaneous mental state language**

extend previous suggestions by adding the notion that experience with the implicit false belief task (through repeating the test trials) does not trigger spontaneous compensatory learning. In contrast to the finding by Schneider et al. [41], Schuwerk, Vuori and Sodian [42] reported apparently contradictory results. They also adapted Senju et al.'s [19] paradigm to test learning effects on false belief-congruent anticipatory looking in adults with ASD. In order to assess the impact of experience on gaze behavior, the critical false belief test trial was repeated once. Eye movement patterns in the first presentation of the false belief test trial revealed the welldocumented group difference between the participants with ASD and the neurotypical controls. However, in the subsequent repetition of the test trial, anticipatory looking of the

Why did Schneider et al. find no effect of experience in a total of ten subsequently presented false belief trials whereas in Schuwerk et al.'s study the single repetition of the false belief trial was sufficient to make the group difference disappear? One task property, which was changed by Schuwerk et al., but not by Schneider et al., can serve as explanation of those discrepant findings. In contrast to previous versions of this implicit false belief task, Schuwerk et al. presented the belief-corresponding action (the agent is searching for the object in the now empty box), and its outcome (the actor does not find the car). Therefore it is possible that presenting a perception-action contingency (agent does not witness the transfer – agent searches for the object in the wrong box) provided a basis for individuals with ASD to learn about the association between the agent's gaze direction and the subsequent action. Notably, this learning from experience can result in the observed alternation of gaze behavior without the need to actually consider the actor's mental state. Thus, this finding suggests that individ‐ uals with ASD are sensitive to behavioral cues to learn about perception-action contingencies. Furthermore, this knowledge can be employed as compensatory strategy to rapidly adapt

In sum, evidence is accumulating that implicit ToM reasoning is impaired in individuals with ASD and also their younger siblings. Moreover, compensatory non-mentalistic strategies, which are useful in explicit ToM tasks, fail to alleviate the deficit to spontaneously appreciate another's mental state. However, recent findings show that the strict distinction that explicit, but not implicit ToM reasoning can be addressed by compensatory learning, may not be tenable. It rather seems that also the implicit ToM deficit can be modulated by compensatory strategies: if individuals with ASD are provided perception-action contingencies, they may also be able to rapidly use this information to anticipate another's false belief-based action. We propose that the implicit ToM deficit in ASD is not as persistent and impenetrable as it seems. Future research has to evaluate possibilities to tackle the lack of spontaneous belief apprecia‐ tion with learning from experience. More evidence for compensatory learning in implicit social cognition would support the previously tentatively stated idea that compensatory strategies

To conclude, the analysis of eye movements has substantially advanced our understanding of ToM reasoning in ASD. The advantage of eye tracking to tap into more implicit social cognitive

can be taught to face impaired implicit social cognitive processes in ASD [43].

ASD group no longer differed from the neurotypical control group.

action predictions in an implicit ToM task.

120 Autism Spectrum Disorder - Recent Advances

**2.3. Summary**

In the second year of life, typically developing children begin to refer to invisible and abstract entities, like their own and others' psychological states. Such states can be volitional states (e.g., "want"), ability terms (e.g., "hard to do"), perceptions (e.g., "see"), physiological states (e.g., "hungry"), emotional states (e.g., "sad"), moral terms (e.g., "good"), or cognitive states (e.g., "know") (cf. also [44]). All of these states have in common that they describe intangible processes within a person. One key aspect of children's mental state references is that they indicate the development of children's explicit, verbally expressible ToM, which begins to emerge in the second year of life. Mental state vocabulary may serve a variety of conversational functions in discourse (e.g., "you know?" is often used in a colloquial way rather than to inquire after someone's knowledge state) and thus might not always indicate psychological compre‐ hension. However, there is evidence for genuine references to mental states (desires, knowl‐ edge, beliefs, emotions) early in development [14].The definition of what a ToM is has different shades of meaning across different areas of research. According to Premack and Woodruff [45] ToM is the ability to attribute mental states to one self and others. This ability can be understood as a "theory" because mental states cannot be observed but have to be inferred. Thus, just like a scientific theory helps researchers explain their data, a ToM helps humans explain the underlying causes of the observable behaviour of others. Since autistic children are impaired in their mental state representation, as assessed in ToM tasks, it seems likely that their spontaneous mental state language production should also be impaired.

The evidence on the development of mental state language in ASD is scarce and partly contradictory. While some studies indicate impairments across a broad range of internal state term categories, others provide evidence for specific impairments or, dependent on the context, even no impairments. For instance, when playing with their preferred toys, children with ASD were specifically impaired in their use of cognitive terms (e.g., "think") and were less otheroriented than neurotypical controls by using fewer mental state terms to call for attention [46]. To detect specific impairments in autistic children, Tager-Flusberg [46] compared 6 boys with Down syndrome (DS) to 6 boys with autism matched for age (range 3 to 6 years) and mean length of utterance (MLU). The children with autism exceeded controls in their use of desire terms (e.g*.,* "want") and references to causes and antecedents of desires. However, they were impaired in their use of cognitive terms and used fewer mental state terms to call for attention. With increasing MLU, autistic children were shown to increase their use of desire, emotion, and perception terms, but not their use of cognitive terms. In contrast, another study [see 9] reported in a sample of 30 autistic children from age 4 to 13 years that in interactions around a wordless picture-book they produced fewer internal state words in any category (emotion, volition, cognition, or perception). Tager-Flusberg [46] reports that in their study the mothers

were asked to select activity toys or games that would best suit the individual interests of the children. Thus, parent-child object play with a familiar toy, due to its interactive nature, might have elicited more desire, perception, and emotion talk in autistic children than would normally be the case. This is corroborated by the fact that in the Tager-Flusberg [46] study autistic children's conversational use of desire terms by far exceeded the genuine use of desire terms. Studies using storybook narratives and memory narratives rather than toys showed that children with ASD were less likely to include terms that referred to cognitive, emotional or perceptual states [46]. Even when using as many internal state terms as controls, children with ASD made less effort to explicate the causes of mental states in their narratives and they were also limited in their ability to monitor and sustain listeners' attention when compared to the narratives of matched controls [47]. This indicates that internal state language might not always be indicative of autistic children's awareness of their own and other's psychological states. This could explain why training autistic children's mental state understanding is not related to their mere use of mental state terms when narrating a wordless picture-book [9], while training their communication of internal state terms in a truly intentional way might be. However, some studies indicate interrelations between autistic children's cognition talk and their overall comprehension of the mind, including more complex emotion understanding. For instance, two studies found significant positive associations between autistic children's use of cognitive terms (while narrating stories to others) and their ToM abilities [48], as well as more specifically, their false belief abilities [49]. In contrast, Losh and Capps [47] found that autistic children's use of mental state terms in personal and storybook narratives (cognitive or affective) were significantly associated with their ability to define emotions, but not to ToM abilities. Recent work [50] showed that autistic children's general ToM scores were related to their use of emotion terms during a wordless picture book interaction, but not to their use of cognition terms. Differences across studies might have to do with context effects on internal state talk. In some contexts autistic children might communicate psychological meaning, in some contexts they might not. Note that internal state talk was assessed differently in each study. Further, as tasks tap into different facets of ToM, including children's comprehension of hidden emotion, moral and irony, developmental links between talk about psychological states and children's conceptual comprehension might also become increasingly complex. In regard to ToM development, consistent with the development of mental state talk in Englishspeaking (Bartsch & Wellman, 1995) [14], as well as in children speaking other languages [51], typically-developing children [52] usually first come to understand own desire and own beliefs, before they come to understand perceptions and others' false beliefs, as well as hidden emotions and finally, children grasp that other people can misconstrue others' minds (secondorder theory of mind) [53]. In contrast, autistic children show the same developmental sequence up to a point, but in the later steps of progression, they show a significantly different sequence of understandings [54]. While they lag behind several years, like in typicallydeveloping children, autistic children's understanding of desires precedes an understanding of belief. In addition, they comprehend knowledge and ignorance before they develop a grasp that someone can hold a belief that differs from reality and is false. In contrast to typical development, autistic children were shown to understand hidden (or false) emotions slightly earlier than false beliefs.

In order to provide a fuller picture, future research needs to explore context effects on autistic children's internal state language. For instance, situations that prove motivating for autistic children are likely to be nonsocial in nature and might involve mechanical systems (e.g., mechanical toys) [55]. These situations might provide autistic children with opportunities to talk about their own volitional and eventually, also emotional states. Consistently, autistic toddlers were found to exceed boys with Down syndrome in their use of desire terms (e.g*.,* "want") and references to causes and antecedents of desires when playing with their own toys [46]. Further, children with autism were found to use less mental state language when describing picture-sequences involving human intentions than controls, while they did not differ from controls when describing pictures depicting behavioral interactions or mechanical actions [56]. Finally, when describing mechanical or intentional launching effects of animated stimuli, 6-to 15 year old autistic individuals [57] were found to use as many mental state terms as controls. What remains unclear is if this kind of mental state talk is related to child ToM. Further, studies need to explore if and how autistic individuals' impaired social attention (e.g., [58]) is related to both children's talk about and comprehension of the mind. According to socio-constructivists, triadic interactions, which emerge at about the end of the first year of life and involve the infant, another person and an object, event, or mental states, are thought to be the basis of children's ToM development (cf. [59]). Note that consistent with the socioconstructivist view of language development, longitudinal work in typically-developing children showed that joint attention skills are developmentally related to children's internal state language vocabulary [16]. A rather general main proposal of the socio-constructivist view is that children actively construe [60] a ToM by interacting and communicating with other individuals, as opposed to "passively" acquiring a theory of mind. According to socioconstructivists, triadic interactions, which emerge at about the end of the first year of life and involve the infant, another person and an object, event, or mental states, are thought to be the basis of children's theory of mind development. For instance, talk about cognitive states within the family is thought to be causally related to inter-individual differences in ToM development. The developmental process itself is gradual and cumulative. This view corresponds to the contextual view of semantic development [61]. In summary, the contextual view emphasizes the relevance of early communicative exchanges in establishing the meaning of mental verbs. It is the functional use of mental state terms in familiar and recurrent contexts, in which children communicate pre-linguistically and verbally with others, which according to this view plays a central role for the development of mental state language. This view suggests that the pre-verbal obtainment of objects (such as the use of proto-imperatives [62] is at the centre of joint attentional communicative exchanges from which desire verbs emerge and that the subsequent linguistic development involves expanding the number of ways of talking about desires within communicative acts. For instance, children have to learn that "like" is used to describe a general preference which is distinct from seeking to obtain something for the moment being, as would be indicated by "want". In sum, the contextual view considers semantic development to be the product of the social practices, framing the purpose of words, the pragmatic purposes of the words, the peculiar syntactic properties of the verbs, and the relevant cognitive development. Turnbull & Carpendale [63] found numerous examples of

were asked to select activity toys or games that would best suit the individual interests of the children. Thus, parent-child object play with a familiar toy, due to its interactive nature, might have elicited more desire, perception, and emotion talk in autistic children than would normally be the case. This is corroborated by the fact that in the Tager-Flusberg [46] study autistic children's conversational use of desire terms by far exceeded the genuine use of desire terms. Studies using storybook narratives and memory narratives rather than toys showed that children with ASD were less likely to include terms that referred to cognitive, emotional or perceptual states [46]. Even when using as many internal state terms as controls, children with ASD made less effort to explicate the causes of mental states in their narratives and they were also limited in their ability to monitor and sustain listeners' attention when compared to the narratives of matched controls [47]. This indicates that internal state language might not always be indicative of autistic children's awareness of their own and other's psychological states. This could explain why training autistic children's mental state understanding is not related to their mere use of mental state terms when narrating a wordless picture-book [9], while training their communication of internal state terms in a truly intentional way might be. However, some studies indicate interrelations between autistic children's cognition talk and their overall comprehension of the mind, including more complex emotion understanding. For instance, two studies found significant positive associations between autistic children's use of cognitive terms (while narrating stories to others) and their ToM abilities [48], as well as more specifically, their false belief abilities [49]. In contrast, Losh and Capps [47] found that autistic children's use of mental state terms in personal and storybook narratives (cognitive or affective) were significantly associated with their ability to define emotions, but not to ToM abilities. Recent work [50] showed that autistic children's general ToM scores were related to their use of emotion terms during a wordless picture book interaction, but not to their use of cognition terms. Differences across studies might have to do with context effects on internal state talk. In some contexts autistic children might communicate psychological meaning, in some contexts they might not. Note that internal state talk was assessed differently in each study. Further, as tasks tap into different facets of ToM, including children's comprehension of hidden emotion, moral and irony, developmental links between talk about psychological states and children's conceptual comprehension might also become increasingly complex. In regard to ToM development, consistent with the development of mental state talk in Englishspeaking (Bartsch & Wellman, 1995) [14], as well as in children speaking other languages [51], typically-developing children [52] usually first come to understand own desire and own beliefs, before they come to understand perceptions and others' false beliefs, as well as hidden emotions and finally, children grasp that other people can misconstrue others' minds (secondorder theory of mind) [53]. In contrast, autistic children show the same developmental sequence up to a point, but in the later steps of progression, they show a significantly different sequence of understandings [54]. While they lag behind several years, like in typicallydeveloping children, autistic children's understanding of desires precedes an understanding of belief. In addition, they comprehend knowledge and ignorance before they develop a grasp that someone can hold a belief that differs from reality and is false. In contrast to typical development, autistic children were shown to understand hidden (or false) emotions slightly

earlier than false beliefs.

122 Autism Spectrum Disorder - Recent Advances

criteria displays (pointing to a person's puzzled look and describing the person to be "think‐ ing") in typically-developing mother-child dyads.

One direct implication of the contextual view is that if the criteria that are normally displayed in parent-child dyads are impaired, as is the case in autism, this might be related to children's delayed ToM performance. Further, mothers might also be influenced by children's skill level. Recent research by Slaughter, Peterson, & Carpenter [64] suggests that mothers' mental state talk is connected to both infants' joint visual attention and their emerging pointing skills. For instance, mothers seem to switch their conversational focus from their infants' visual behav‐ iour and experiences to the object of their mutual attention and children's imperative pointing gestures are directly followed by mothers' talk about volitions and intention, while later, declarative gestures are followed by both, epistemic and cognitive state talk. If children point less, this might lead parents to talk less. For instance, in a case study [65], all parental talk directed to a young child with autism at home over a day-period was analysed for internal state language focusing explicitly on the thoughts, feelings, and perceptions of animate beings. Compared to what has been found in parents of typically developing children, the parents rarely elaborated on the causes and consequences of these internal states and they primarily referred to sensory and desire terms (the mother did so in 24% of her utterances, while the father did so in 33% of his utterances).

#### **3.2. Later explicit, spontaneous ToM: Mind-Mindedness**

There is ample evidence for a deficit in ToM for others in adults with ASD (see [66] for a review). More specifically, autistic adults are severely impaired in their ability to decode affective (e.g., reading emotions from the eye region) and cognitive states. There is, however, a growing dissatisfaction with the tasks used to assess ToM abilities in adults with ASD.

One prominent task to measure autistic individual's emotion understanding (affective ToM) is the Reading-the-Mind-in-the-Eyes task (RME task; [3]). The task contains 36 black/white photographs of the eye region expressing complex mental states in terms of emotions, such as 'jealous', 'bored', or 'admiring'. Participants have to distinguish the correct mental state from three distractors (i.e., mental state terms with the same emotional valence as the target) on each trial. Previous research has shown that the performance on the RME task is inversely correlated with the degree of autistic impairments and is significantly lower in autistic adults when compared to controls (e.g., [67,68]). Autistic individual's comprehension of cognitive states is usually measured with the Strange Stories-test [69]. This test is also called the short stories task and comprises five mental short stories referring to five different advanced ToM abilities: double bluff, white lie, deception, misunderstanding, emotion understanding. The short stories require participants to provide mental state justifications for story characters' nonliteral statements and thus measure ToM for others. Research has shown a general deficit on advanced ToM tasks in adults with ASD which appears on the social-perceptual level, as well as on the conceptual level, with reference to self and others (e.g., [70]), In regard to ToM for other, the worse performance of the ASD group on the RME task compared to controls provides further evidence for an impairment of social–perceptual processes, which enable mental state decoding from nonverbal cues (i.e., eye gaze), in ASD (e.g., [3]). The results from the mental short stories clearly indicate that adults with ASD have difficulties in providing mental state justifications for story characters' nonliteral statements (i.e., double bluff, white lie, deception, misunderstanding), as well as in emotion understanding. In most studies, the deficit in mental state reasoning observed in ASD appears largely independent of verbal and non-verbal intelligence. Few studies have explored ToM for self, with results indicating severe and specific deficits in self-knowledge in ASD (see [71]). In sum, the assessments of ToM abilities and deficits in adults with ASD are highly specific, posing considerable verbal demands, and neglecting a wide range of competencies underlying spontaneous mentalizing.

criteria displays (pointing to a person's puzzled look and describing the person to be "think‐

One direct implication of the contextual view is that if the criteria that are normally displayed in parent-child dyads are impaired, as is the case in autism, this might be related to children's delayed ToM performance. Further, mothers might also be influenced by children's skill level. Recent research by Slaughter, Peterson, & Carpenter [64] suggests that mothers' mental state talk is connected to both infants' joint visual attention and their emerging pointing skills. For instance, mothers seem to switch their conversational focus from their infants' visual behav‐ iour and experiences to the object of their mutual attention and children's imperative pointing gestures are directly followed by mothers' talk about volitions and intention, while later, declarative gestures are followed by both, epistemic and cognitive state talk. If children point less, this might lead parents to talk less. For instance, in a case study [65], all parental talk directed to a young child with autism at home over a day-period was analysed for internal state language focusing explicitly on the thoughts, feelings, and perceptions of animate beings. Compared to what has been found in parents of typically developing children, the parents rarely elaborated on the causes and consequences of these internal states and they primarily referred to sensory and desire terms (the mother did so in 24% of her utterances, while the

There is ample evidence for a deficit in ToM for others in adults with ASD (see [66] for a review). More specifically, autistic adults are severely impaired in their ability to decode affective (e.g., reading emotions from the eye region) and cognitive states. There is, however, a growing

One prominent task to measure autistic individual's emotion understanding (affective ToM) is the Reading-the-Mind-in-the-Eyes task (RME task; [3]). The task contains 36 black/white photographs of the eye region expressing complex mental states in terms of emotions, such as 'jealous', 'bored', or 'admiring'. Participants have to distinguish the correct mental state from three distractors (i.e., mental state terms with the same emotional valence as the target) on each trial. Previous research has shown that the performance on the RME task is inversely correlated with the degree of autistic impairments and is significantly lower in autistic adults when compared to controls (e.g., [67,68]). Autistic individual's comprehension of cognitive states is usually measured with the Strange Stories-test [69]. This test is also called the short stories task and comprises five mental short stories referring to five different advanced ToM abilities: double bluff, white lie, deception, misunderstanding, emotion understanding. The short stories require participants to provide mental state justifications for story characters' nonliteral statements and thus measure ToM for others. Research has shown a general deficit on advanced ToM tasks in adults with ASD which appears on the social-perceptual level, as well as on the conceptual level, with reference to self and others (e.g., [70]), In regard to ToM for other, the worse performance of the ASD group on the RME task compared to controls provides further evidence for an impairment of social–perceptual processes, which enable mental state decoding from nonverbal cues (i.e., eye gaze), in ASD (e.g., [3]). The results from the mental

dissatisfaction with the tasks used to assess ToM abilities in adults with ASD.

ing") in typically-developing mother-child dyads.

124 Autism Spectrum Disorder - Recent Advances

father did so in 33% of his utterances).

**3.2. Later explicit, spontaneous ToM: Mind-Mindedness**

In developmental research, the concept of Mind-Mindedness (MM) has been productively used by Meins and her colleagues to capture individual differences in the spontaneous tendency to conceive of a person in mentalistic (as oposed to behavioural) terms. Meins, Fernyhough, Russell & Clark-Carter, 1998 [72] first studied the concept in mothers by letting them describe their children. They found that mothers differ in the degree to which they reflect upon their children in mentalistic terms rather than based on their outward appearance or behaviour. Thereby, a greater number of mental terms (e.g., "*he is reflective*") instead of behavioural terms (e.g., "*he likes to ride his bike*"), physical (e.g., "*he has brown hair*") or general terms (e.g., "*he is my neighbour*") indicate a higher degree of mindedness in regard to others' mind (mind-mindedness) (cf. [73]). Meins and colleagues [73] have since extended the concept to friends, romantic partners and works of art.

If individuals with ASD are impaired in their everyday, spontaneous ability to conceive of themselves and others as mental agents, then this deficit should be reflected in their person descriptions. To date, the concept has only been employed in one study [74] with respect to self-descriptions. Few studies have investigated self-concepts of individuals with ASD at all (e.g., [75]). In an early study, Lee and Hobson [76] employed a self-understanding interview [77] in a sample of children and adolescents with and without ASD and found that participants with ASD produced significantly fewer self-descriptors scored as "social" compared to controls. Further, an elaborated analysis of the content of psychological statements highlighted qualitative differences: More than half of the psychological self-descriptors in the ASD group referred to preferred activities (e.g., 'I like swimming.'). The study by Kristen, Rossmann, Sodian, [74], used the MM-task adapted from Meins & Fernyhough (cf. [73,78]). Since MM was assessed in adults, a representational measure of MM was used. Participants were given a simple, open-ended instruction: "Can you describe yourself for me? What kind of a person are you? Tell me everything you consider as important to describe yourself!" Participants were not given any hints on how to answer the question. The results suggest that when compared to typically-developing controls, individuals with ASD use fewer mental self-descriptors, which appears to point to their inability to reflect on their own mental states in a mind-minded way. This result remained stable when controlling for verbal and non-verbal IQ.

The following paragraph is an example (translated from German) of an autistic male's selfdescription referring mainly to general information and physical aspects.

*"First, my age and I have siblings and so on. I am 37 years of age and will turn 38 on the 29th of november. My hobbies are varied: I hike, I ride my bike, I watch TV, I go to the theatre and to the ballet, the opera. I perform on stage and I write poems. I have brown-blond hair and blue eyes. I always smile. I have had* *surgery, but I don't want people to know. I'm autistic and this is important for people to know. I also repeat myself sometimes. But I will manage this problem. I work 8 hours a week. I'm very interested in the weather, that is my work and in maps, as a hobby. Sometimes I read books".*

The following paragraph constitutes a more mind-minded description from a participant from the control group. Note that even a less talkative person's self-reflection can contain a high percentage of mind-minded comments. This demonstrates that mind-mindedness is inde‐ pendent of verbosity. The paragraph also shows the relatively low levels of general and behavioral information in a typically-developing person's self-description.

*"I am a very considerate person. I reflect a lot upon myself and others. I am also very sensitive and interested in artistic aspects of human existence. I am also a bit arrogant, or at least, others might think I am arrogant. But I am also honest and trustworthy. "*

ToM for self does not take into account the accuracy or appropriateness of mental state ascriptions (cf. [73]). Thus, it remains an open question how appropriately autistic adults reflect on themselves. Consequently, studies need to address not only if, but how appropriately ASD patients ascribe mental states to themselves.

Since impaired ToM for self is connected to an impaired episodical, autobiographical memory it might also be seen as a valid indicator of an impaired identity development in autism. In contrast to semantic traces, episodic traces cannot be formed (i.e., events cannot be encoded as experienced) without a ToM. According to Tulving [79,80] and colleagues [81], the involve‐ ment of self (autonoetic) consciousness is assumed to be critical for episodic autobiographical memory in adulthood. Thus, episodic memory deficits in adults with autism might be due to a diminished level of self-consciousness at encoding. The work by Kristen et al. [74] showed a specific correlation between MM for self and personal episodic memory that was independ‐ ent of verbal and non-verbal IQ and that can be interpreted in terms of introspection. Intro‐ spection is essential for ascribing mental states to oneself as well as for re-experiencing personal episodic memories. A study by Perner et al. [82] showed that a modality-specificity test of ToM, which required introspection, yielded the highest predictive value of episodic memory performance compared to other ToM tasks. This was seen as evidence that introspection is functionally related to children's understanding of the sources of their experience. More specifically, when children re-experience (i.e., remember actively) a past event, they have to understand that the origin of this experience lies in the past (understanding source of experi‐ ence) and that this experience is a representation of the original experience (meta-representa‐ tional understanding). Further, the correlation might reflect autobiographical meaning making skills. It has been proposed that the construction of autobiographical memories constitutes a complex, narrative process [83,84]. Thereby, the use of mental state terms is a good indicator that one has formed organized explanatory accounts of past events that are integrated with a subjective perspective on one's own thoughts and emotional reactions to autobiographical events [85]. Further, if autobiographical memories are less coherently constructed this, in turn, might lead to the need for more prompts to retrieve personal episodic memories. In support of this view, a study of young school-children [86] suggests that controlled retrieval processes are required to tell about one's past. Like younger children, individuals with ASD might have a less coherently constructed cognitive memory network (i.e., they might not have linked causes to consequences of events) and thus, they might also encounter difficulties in triggering specific nodes within that semantic network (cf. [87]).

#### **3.3. Summary**

*surgery, but I don't want people to know. I'm autistic and this is important for people to know. I also repeat myself sometimes. But I will manage this problem. I work 8 hours a week. I'm very interested in*

The following paragraph constitutes a more mind-minded description from a participant from the control group. Note that even a less talkative person's self-reflection can contain a high percentage of mind-minded comments. This demonstrates that mind-mindedness is inde‐ pendent of verbosity. The paragraph also shows the relatively low levels of general and

*"I am a very considerate person. I reflect a lot upon myself and others. I am also very sensitive and interested in artistic aspects of human existence. I am also a bit arrogant, or at least, others might think*

ToM for self does not take into account the accuracy or appropriateness of mental state ascriptions (cf. [73]). Thus, it remains an open question how appropriately autistic adults reflect on themselves. Consequently, studies need to address not only if, but how appropriately ASD

Since impaired ToM for self is connected to an impaired episodical, autobiographical memory it might also be seen as a valid indicator of an impaired identity development in autism. In contrast to semantic traces, episodic traces cannot be formed (i.e., events cannot be encoded as experienced) without a ToM. According to Tulving [79,80] and colleagues [81], the involve‐ ment of self (autonoetic) consciousness is assumed to be critical for episodic autobiographical memory in adulthood. Thus, episodic memory deficits in adults with autism might be due to a diminished level of self-consciousness at encoding. The work by Kristen et al. [74] showed a specific correlation between MM for self and personal episodic memory that was independ‐ ent of verbal and non-verbal IQ and that can be interpreted in terms of introspection. Intro‐ spection is essential for ascribing mental states to oneself as well as for re-experiencing personal episodic memories. A study by Perner et al. [82] showed that a modality-specificity test of ToM, which required introspection, yielded the highest predictive value of episodic memory performance compared to other ToM tasks. This was seen as evidence that introspection is functionally related to children's understanding of the sources of their experience. More specifically, when children re-experience (i.e., remember actively) a past event, they have to understand that the origin of this experience lies in the past (understanding source of experi‐ ence) and that this experience is a representation of the original experience (meta-representa‐ tional understanding). Further, the correlation might reflect autobiographical meaning making skills. It has been proposed that the construction of autobiographical memories constitutes a complex, narrative process [83,84]. Thereby, the use of mental state terms is a good indicator that one has formed organized explanatory accounts of past events that are integrated with a subjective perspective on one's own thoughts and emotional reactions to autobiographical events [85]. Further, if autobiographical memories are less coherently constructed this, in turn, might lead to the need for more prompts to retrieve personal episodic memories. In support of this view, a study of young school-children [86] suggests that controlled retrieval processes are required to tell about one's past. Like younger children, individuals with ASD might have a less coherently constructed cognitive memory network (i.e., they might not have linked

*the weather, that is my work and in maps, as a hobby. Sometimes I read books".*

behavioral information in a typically-developing person's self-description.

*I am arrogant. But I am also honest and trustworthy. "*

patients ascribe mental states to themselves.

126 Autism Spectrum Disorder - Recent Advances

In sum, studies in autistic children as well as in adults demonstrate a clear deficit in referring to internal states. Further, autistic individuals also lack the ability to comprehend mental states. Thereby, early in development children might lack implicit understanding needed for interactions involving joint attentional cues [88], which in turn, might lead to delayed and impaired mental state language development. Further, work from our own laboratory (Kristen, Vuori, Sodian,[89] submitted) suggests that even if autistic children refer to internal states, it is only the internal state language they utter in a joint attention context in combination with their sustained attention that is related to children's more complex ToM-skills. One possible reason is input poverty, since parents might use less complex internal state language towards children who provide them with fewer joint attention cues and are less attentive. As a result, as adults autistic individuals are not only impaired in their spontaneous explicit ToM, involving implicit decoding skills (as measured by the REM task), but also show deficits in explicit mental verb usage (as measured by the Mind-Mindedness task) that might be based on joint attention deficits.

To conclude, studies on spontaneous explicit ToM support the idea of a ToM deficit in autism. Impairments occur independently of verbal and non-verbal IQ. Thus, the deficit seems to be specific.
