The Interface Between Thery f Mind and Language Impairment By Lauren Lwry Hanen Certified SLP and Clinical Staff Writer When mst f us hear the term thery f mind we usually think abut children with autism spectrum disrder since they have deficits in this area. But anther grup f children is receiving attentin when it cmes t research abut thery f mind: children with specific language impairment (SLI). T date, research has been incnclusive regarding the thery f mind abilities in children with SLI. While sme studies shw that children with SLI have prer thery f mind abilities than typically develping children, ther research shws n difference between these tw grups f children. One prblem with previus research is the small sample sizes frm which cnclusins were drawn (Nilssn & de López, 2016). Terminlgy Befre ging any further we need t clarify sme terminlgy: Thery f mind refers t the ability t attribute mental states t neself and thers in rder t explain behaviurs The term specific language impairment is used by many researchers and clinicians t refer t marked language impairment in the absence f neurlgical r sensry dysfunctin, and despite nrmal nnverbal intelligence Specific language impairment has been remved frm the DSM-5 and replaced with Language Disrder. Hwever, in rder t be cnsistent with Nilssn & de López s use f the term specific language impairment, I use the term belw t mst accurately describe their findings. (Nilssn & de López, 2016)
Hping t vercme this limitatin and bring clarity t this debate, Nilssn & de López (2016) cnducted a metaanalysis f studies cmparing the thery f mind abilities in typically develping children and children with SLI. Meta-Analysis Nilssn & de López s (2016) literature search revealed 17 relevant studies f children between the ages f 4 t 12 (fr a ttal f 745 children). Studies included in the review met the fllwing criteria: They included tw cmparisn grups matched in terms f chrnlgical age: typically develping children (ttal n = 416) and children with SLI (ttal n = 329) Children in the SLI grups had a diagnsis f specific language impairment Nilssn & de López didn t frm any hyptheses at the beginning f their meta-analysis since past studies revealed incnsistent results. Besides lking at thery f mind abilities, the authrs als analyzed whether age r gender mderated the differences between the tw grups abilities. Results f the Meta-Analysis Nilssn & de López fund that: Children with SLI demnstrated significantly lwer thery f mind perfrmance than age-matched typically develping children Neither age nr gender mderated the studies effect sizes What d these results mean? Language ability is cnnected t thery f mind ability These results lend supprt t an assciatin between language and thery f mind. Because the primary difficulties in SLI are with language skills, it is likely that impaired language is the mst prbable explanatin fr the thery f mind challenges seen in children with SLI (Nilssn & de López, 2016). What cannt be gleaned frm these results is exactly hw language difficulties influence the develpment f thery f mind. Des a cmmn denminatr underlie bth language and thery f mind? Nilssn & de López prpse that the language-thery f mind cnnectin may nt be s straightfrward, and perhaps a cmmn mechanism underlies the develpment f bth skills, such as executive functining r etilgical mechanisms (genetic r envirnmental factrs). Hwever, results frm the meta-analysis culd nt clarify this cnnectin. Perfrmance factrs prbably didn t cntribute t the children s perfrmance
One might wnder whether the children s language impairment interfered with their ability t perfrm n tests f thery f mind. Hwever, the linguistic demands f such testing likely didn t interfere with the results because: the thery f mind tests included simple verbal instructins that were usually supprted by visual aids pre-tests ensured children s memry and cmprehensin abilities were sufficient fr testing bth verbal and less verbal tasks were used t assess thery f mind, and n cnsistent pattern was fund in children with SLI acrss these tasks Nilssn & de López explain that these factrs indicate that children with SLI likely have true thery f mind challenges that can t be explained by the verbal demands required fr thery f mind testing. Is thery f mind delayed r disrdered in SLI? Tw factrs pint tward delayed develpment f thery f mind in children with SLI: Children with SLI exhibit eye gaze patterns similar t typically develping children during scial situatins (whereas children with autism spectrum disrder pay less attentin t faces and their gaze tends t shift t the periphery f scial situatins) Sme studies shw that children with SLI demnstrate thery f mind abilities that are cmparable t yunger language-matched typically develping children (Nilssn & de López, 2016) Hwever, this desn t mean that children with SLI eventually catch up in their thery f mind abilities. Rather, sme evidence reveals thery f mind impairments may endure int adlescence and adulthd in individuals with SLI. Perhaps this plays a rle in the prer scial utcmes bserved in children with SLI (Nilssn & de López, 2016). Prmting thery f mind in children with language impairment Given the results f their meta-analysis, Nilssn & de López suggest that, interventins aiming t imprve the TfM [thery f mind] abilities f children with SLI may be cntemplated as an adjunct t cnventinal language prgrams (p. 150) But here s the prblem ur traditinal tlbx fr treating language impairment desn t cme with a thery f mind manual! We need t think ut f the bx in rder t prmte this skillset while cntinuing t address the many ther gals we have when wrking with children with language impairment. While mre research is needed in this area, researchers have prpsed several language skills that might be related t thery f mind develpment, and these can give us clues abut where t start in interventin (Nilssn & de López, 2016):
mental state wrds - children need t understand wrds that describe mental states, such as want, believe, and think. Mdeling these types f wrds helps children tune-in t their wn feelings and thers perspectives. Caregivers can mdel mental state wrds by putting their child s feelings, wants, and perspectives int wrds, and explaining why peple d the things they d. A gd place t start is with the mental state wrds want and like as these develp earliest. Emphasizing peples wants and likes can happen during an everyday activity like mealtime, where the child s likes are cmpared with ther family members likes (e.g. Yu like chclate cake but Daddy and I like vanilla ). cmplement clauses - certain syntactical abilities are needed t express peples perspectives. One example is the ability t use cmplement clauses, like I think that Peter is sleeping (the clause that Peter is sleeping cmplements the verb think ). Mdeling sentences that begin with wrds abut thinking (e.g. think, knw, frget, remember, understand, etc.) builds understanding f tuning-in grammar (e.g. I think that it s ging t rain, He knws that yu are upset, r She frgt abut yur birthday ). cnversatinal exchanges when children engage in everyday cnversatin, they learn that different peple have different pints f view. When caregivers have cnversatins with their child, they can express ideas abut their pinins, what they are thinking, and why they are ding the things they are ding. Research has nt yet priritized which f these language skills has the mst impact n the develpment f thery f mind (Nilssn & de López, 2016). Sme children with language impairment may nt be ready fr wrk n the abve skills, s lking at sme f the early precursrs f thery f mind can help with gal selectin, including: Engagement and jint attentin face-t-face interactins during which children are emtinally engaged help them ntice thers and what they are ding. This ability is needed t build perspective taking. Engagement and jint attentin can be prmted by encuraging caregivers t fllw their child s lead and engage in enjyable activities that spark their child s interests. Talking abut what the child is ding and what the adult is ding and thinking during these mments can help build perspective taking. Pretend play when a child takes n a pretend rle, he needs t think abut and re-enact anther persn s perspective and behaviur. Early pretend play with tys and rle play can therefre help children tune in t ther peple s pints f view. There are many ther ideas abut helping children tune in t thers in TalkAbility: Peple skills fr verbal children n the autism spectrum A guide fr parents In cnclusin While we may nt immediately think abut wrking n thery f mind when we plan interventin fr children with language impairment n ur caselads, the research is becming increasingly clear abut this area f difficulty fr
these children. We need t ensure that they have the skills they need in rder t develp all aspects f their cmmunicatin abilities, including thery f mind. Fr mre infrmatin abut the develpment f thery f mind, have a lk at ur article Thinking abut Thinking: Hw yung children develp thery f mind. We als have articles n ur website geared twards parents and ther caregivers: The Truth Abut Kids' Lies - describes hw the ability t lie is related t thery f mind Tuning-in t thers: Hw yung children develp thery f mind - a summary f thery f mind develpment and tips fr prmting tuning in References Nilssn, K. K. & de López, K. J. (2016). Thery f mind in children with specific language impairment : A systematic review and meta-analysis. Child Develpment, 87(1), 143-153. Sussman, F. (2006). TalkAbility Peple skills fr verbal children n the autism spectrum: A guide fr parents. Trnt, ON: Hanen Early Language Prgram. Abut The Hanen Centre Funded in 1975, The Hanen Centre is a Canadian nt-fr-prfit charitable rganizatin with a glbal reach. Its missin is t prvide parents, caregivers, early childhd educatrs and speech-language pathlgists with the knwledge and training they need t help yung children develp the best pssible language, scial and literacy skills. This includes children wh have r are at risk fr language delays, thse with develpmental challenges such as autism, and thse wh are develping typically. Fr mre infrmatin, please visit www.hanen.rg. The Hanen Centre is a Registered Charitable Organizatin (#11895 2357 RR0001)