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date: 25 September 2017

Theory of Mind and Communication in Health and Risk Messaging

Summary and Keywords

Humans live not only in a physical world but also in a mental world. Theory of mind reflects the understanding that the mind is comprised of different mental states, such as intentions, desires, and beliefs. This conception of the mind is a critical achievement in human development because it directly impacts effective communication and social interaction. It allows for the understanding of others’ behaviors by inferring their mental states. The formation of a theory of mind has been a central topic in psychology, neuroscience, cognitive science, and philosophy. It impacts related processes, such as communication skills, perspective-taking ability, and social cognition.

Across the life span, the understanding of the mind becomes increasingly complex. Early in development, infants and toddlers can discern the intentions of others. Later, more sophisticated reasoning about the mental states of others becomes possible. For instance, the ability to follow and understand the recursive thought that “Sam believes, that Mary said, that Jose wanted . . . develops. Additionally, within distinctive developmental time periods, people differ in their ability to take into account mental states. Once people’s beliefs, including their misconceptions, are identified, it is possible to generate effective communication strategies designed to teach, learn, and even reduce risk-taking behaviors.

Keywords: theory of mind, false belief understanding, communication, intrapersonal communication, language, neuroscience, perspective-taking, risk, intervention

Theory of Mind

Theory of mind concerns the understanding of mental states and their relation to perception and action. Consider the following scenario: Mary puts her backpack on the kitchen table and then goes out with her friends. While she is away, Matthew moves it to her bedroom. Later, when Mary returns home, she goes into the kitchen and then leaves and walks in and out of different rooms. Without knowledge of mental states, it would be difficult to adequately explain Mary’s behavior. However, by utilizing a theory of mind, Matthew would conjecture that Mary wanted her backpack, thought it was in the kitchen because she remembered leaving it there, and quickly left because she believed it must be somewhere else. Further, Matthew knows why Mary is looking in the kitchen for it, even though he knew it was in her room. That is, he understands that Mary has a false belief, a belief about a situation that differs from reality. Matthew has demonstrated false-belief understanding in this scenario.

As the above example illustrates, there are many different mental states (e.g., desires, beliefs, remembering). Depending on the mental state, the relation of experience and action varies. For instance, wanting something, such as a dessert, emerges from physiological (e.g., hunger) or emotional needs (love). If someone’s desire is known then, it is possible to predict his or her action. More complex mental states, such as beliefs, often emerge from perception. Someone who looks inside a box knows what it contains compared to someone who does not look. Children understand this relation around 3 years of age.

Theory of mind is an element of a larger branch of psychology concerned with social cognition or how people think about social phenomenon, including perspective-taking ability and cognitive biases. While the topics overlap, theory of mind focuses on mental states. The term “theory of mind” has two uses. The first is used as a general label for all of cognition, behavior, and action that falls under theory of mind. The second use reflects the description of this understanding as a theory about the mind, a “folk psychology” that functions in much the same way that scientists have theories about different phenomenon. Similarly related processes have been described in other disciplines, including communication, philosophy, and evolutionary biology.

Understanding other minds is central to most human activity; it is what distinguishes humans from other primates (Tomasello, 2014). Interestingly, the modern day study of theory of mind can be traced to a question regarding whether chimpanzees have a theory of mind (Premack & Woodruff, 1978). That is, do they impute mental states to other primates? The false belief task was identified as the best indicator of having a theory of mind. Studies over the past 30 years have demonstrated that chimpanzees fail false belief tasks (see Call & Tomasello, 2008, for a review). Recently, however, in a study using anticipatory looking behavior, chimpanzees successfully anticipated where the participant should look if operating with a false belief, suggesting at least an implicit theory of mind (Krupenye, Fumihiro, Hirata, Call, & Tomasello, 2016).

Historical Influences

Prior to current investigations into theory of mind, related processes had previously been examined from other researchers and disciplines. The famed Swiss developmental psychologist Jean Piaget (1896–1980) investigated children’s understanding of different mental states, such as thinking and dreaming, through a series of interviews. Only gradually did children develop a comprehensive understanding of mental states. Additionally, Piaget documented changes in children’s perspective-taking abilities. Similar to the developmental trajectory for false-belief understanding, during the late preschool years, children become more proficient at taking the perspectives of others. These children, for instance, can recognize that others may desire or see something different from them (Piaget, 1954). Philosophers have long been concerned with language and mental states. Goldman (2012) traces this interest to Sellars (1956) who argued that the commonsense or “folk psychology” reflects a protoscientific theory. There are also disagreements regarding whether mental states are real and provide predictive utility (Fodor, 1987) or are part of a false theory (Churchland, 1981).

Theories of Theory of Mind

Different theoretical perspectives describe the development of theory of mind, many of them have focused on explaining false-belief understanding. One of the earliest conceptualizations of theory of mind was from a modularity perspective (Baron-Cohen, 1995). Modularity approaches to cognition conceptualize the mind as comprised of distinct modules defined by specialized knowledge, such as language, spatial cognition, object knowledge, and theory of mind. These specialized modules reflect evolutionary processes of selecting knowledge domains central to human survival. The modularity approach to theory of mind initially proposed a series of four specialized mechanisms, including an intentionality detector, a shared attention mechanism, an eye-direction detector, and a theory of mind module. Each of these modules reflect a different aspect of the mind. One line of support of the modularity view derives from children with autism spectrum disorder (ASD). Individuals with ASD exhibit difficulties in social communication and repetitive patterns of behaviors/restricted interests and activities. It has been proposed that some of these difficulties are due to selective deficits in theory of mind understanding, which Baron-Cohen refers to as “mindblindness” (Baron-Cohen, 1995). Children with ASD experience limitations in all these modules, including engaging in shared attention with another about an object. These children also do not recognize that eye gaze something about their thoughts or attention. This theory of mind view of autism has undergone revision because it does not account for all the characteristics of the disorder. Nevertheless, performance on theory of mind tasks has been associated with communication difficulties in both typical and atypical populations.

A second explanation of theory of mind is simulation theory (Harris, 1992). According to this theory, to understand others’ mental states, children need to think in others “shoes” and consider what they would experience in a similar situation. Children understand people’s minds through simulations of their minds. Support for the simulation theory comes from research on the mirror neuron system (MNS) (e.g., Gallese & Goldman, 1998). The MNS is a network including the inferior frontal and inferior parietal brain regions, which are engaged not only in perceiving but also in executing the same actions from others. Because of MNS’s critical role in mapping others’ actions, it has been suggested that MNS aids in acquisition of theory of mind via simulation.

A third view of theory of mind, the executive function account, emphasizes the role of inhibitory control. Executive functions are basic cognitive processes that regulate and control behavior, including working memory, inhibitory control, planning. To pass a false-belief task, individuals must inhibit their own knowledge of the situation and answer based on the other’s belief. Theory of mind is associated with inhibitory control in childhood, and it continues to improve after inhibitory control reaches adult levels (Dumontheil, Apperly, & Blakemore, 2010). This means the two may grow together initially but diverge in development. In addition, neural research also shows an overlap between theory of mind and executive functioning in the brain, the prefrontal cortex, supporting a relation between the two.

The fourth view of theory of mind, sometimes referred to as “folk psychology” or the “theory theory view” proposes that people have a naïve theory about the mind that involves an understanding of the relation between different mental states and behavior. Someone who knows a fact about a phenomenon has a different mental state than someone who believes a fact. The theory view proposes that the understanding of mind shares some similarity to a scientific theory in the sense that it invokes nonobservable causal mechanisms (mental states) to predict behavior, undergoes revision with experience, and focuses on a specific cognitive domain (Gopnik & Wellman, 1992).

Theory of Mind Across the Life Span

Infancy and Early Childhood

As discussed, earlier childhood is a critical period in the development of theory of mind understanding. Even during infancy, children have some understanding of the mind, particularly intentionality in which others behave in goal-directed ways. This is evident by around 8 months of age, when infants recognize that others act in purposeful ways as reflected in intentional communication. When infants are unable to reach a desired object, they will alter between looking at the object and their caregiver. Such gaze switching indicates they recognize that others are intentional agents who can help achieve a desired goal.

Between 2 and 5 years of age, children make substantial progress in theory of mind development and understand:

  • Diverse desires. Children know that people can differ in the items they like, such as strawberry or chocolate ice cream. If one child likes chocolate ice cream, s/he can predict that other children who enjoy strawberry ice cream will select that as their snack.

  • Diverse beliefs. Children know that two people can have different beliefs about something, if they do not know which one is true.

  • Knowledge access. Children understand that an individual can know something that others do not know because of differences in experience.

  • False beliefs. Children understand that other people can have a belief that is different from their own belief or the reality.

  • Hidden emotions. Children recognize that people can feel an emotion that they are not displaying, e.g., such as looking surprised but are not actually surprised.

This formation of false belief is a critical milestone in cognitive development because it qualitatively changes the understanding of another person’s behavior. Interest in its development has generated hundreds of studies over the past 25 years. Once children understand that beliefs are not direct copies of reality, but are representations which can be true or false, they utilize this understanding to surprise, deceive, and trick others. More broadly, they can communicate effectively because they understand different perspectives and can adjust their messages accordingly. To assess false-belief understanding, children are typically given an unexpected content or location task. In the standard, unexpected content, false-belief task, 3- to 5- year-olds are shown a familiar container, such as a crayon box, and are asked what they think is inside the box. All children will likely reply that it contains crayons. The box is opened to reveal that it contains batteries, which are then returned to the box. When asked what Grover, who has never looked inside the box, thinks it is inside the closed box, 3-year-olds reply “batteries” whereas, 5-year-olds say “crayons” because they are aware that Grover’s belief is false and differs from their belief and reality. Similarly, in an unexpected location task, children are told a story about an object being moved to a new place. In the Sally–Anne story, Sally puts her marble in a basket. While Sally is away, Anne moves Sally’s marble to the box. The child is then asked where Sally will look for the marble when she returns. If children understand false belief, they will answer “the basket.” Numerous studies have documented this universal achievement in a wide range of countries, including China, Peru, India, and Thailand. Further, this developmental pattern is reliable and does not change with task variations (Wellman, Cross, & Watson, 2001).

Explanations of False-Belief Development

The theories reviewed above focus broadly on theory of mind, as well as false-belief understanding. Further refinements focus specifically on explaining false-belief development. According to a linguistic determinism argument, to represent a false belief the child needs to acquire the complement grammatical structure. A complement structure is one in which a mental (think) or communication verb (say/told) is followed by a complement clause. Consider this sentence: Jared thought that the cake was in the pantry, but it was really in the refrigerator. The truth of Jared’s mental state does not depend on the reality of the cake’s location. The complement structure allows a split between the Jared’s belief and the actual reality—the essence of false-belief understanding. Complements with communication verbs are acquired earlier and lay the linguistic foundation for the later development of false belief (de Villiers, 2005). Both correlational and training studies have documented that complementation acquisition predicts false-belief understanding in typically developing children. The difficulties that children with ASD show on false-belief tasks are linked to poor complementation understanding. Similarly, children with specific language impairment, in which there is a lag in acquiring language with no neurological difficulties, are also delayed in false-belief understanding. This delay has been linked to their language delays, including complementation. Finally, children who are deaf and born to hearing parents are lag in false-belief understanding because of language and complementation limitations. This does not occur for deaf children with deaf parents because the children learn sign language early as a native signer (Schick, de Villiers, de Villiers, & Hoffmeister, 2007).

Alternatively, according to the social constructivist perspective, it is through linguistically mediated social interactions with others that children become aware that minds differ (Meins, Fernyhough, Arnott, Leekam, & Rosnay, 2013). In this view, complementation is not necessary for false-belief understanding. Theory of mind is constructed through everyday conversations and joint book reading between parents and children. These social interactions involve mental state talk in which the behaviors of others are interpreted by appealing to their mental states. Parents might explain to a child that Elmo is angry with Big Bird because he thought Big Bird took his toy. Families who frequently engage in mental state talk facilitate their children’s understanding of false belief. These conversations tend to be less frequent in children with language delays, such as ASD and specific language impairments.

Challenges to False Belief Development

According to the standard view of theory of mind, the development of false belief understanding between 3 and 5 years of age reflects a major conceptual change in children’s theory of mind understanding. This view has been challenged though by recent research on infants and toddlers suggesting that an implicit understanding of false belief develops earlier (Gweon & Saxe, 2013). Using a violation-of-expectancy procedure, infants watch a story of an unexpected location situation. When the person in the story searches in the object’s new location, infants’ indicate surprise-presumably because they know the person should look in the location the object was recently hidden (e.g., Onishi & Baillaregeon, 2005), Similarly, 24-month-old toddlers’ anticipatory looking also indicated some understanding of false beliefs (Southgate, Senju, & Csibra, 2007). Therefore, some researchers (Apperly & Butterfill, 2009) proposed that there are two separate cognitive mechanisms underlying theory of mind: an “early emerging, automatic but inflexible” process for infants’ success on looking time paradigm and a “later-emerging, flexible and effortful” process for preschool children’s success on standard false-belief tasks. However, critics also question the validity of the looking time paradigm to test false-belief understanding. For example, Low and Perner (2012) argue that it’s possible that infants can just rely on simply behavior rules such as “people look for objects where they last saw them” to succeed on the task. Moreover, the neural bases of false-belief reasoning have been well established in adults. While similar neural bases have been identified in children and adolescents, there are no significant neural changes associated with passing false-belief tasks at 5 years of age (Gweon & Saxe, 2013). Together, these findings suggest that false-belief understanding at age 5 may not represent a conceptual change but perhaps a transition from an implicit to explicit understanding.

Theory of Mind in Middle Childhood and Adolescence

Once children understand false belief, further achievements in theory of mind development occur. Mental states such as beliefs and thoughts are recursive, meaning they can, in theory, be repeated infinitely. These recursive thinking loops involve stories reflecting statements such as “Jose thinks that Jessica believes that Lauren thinks that. . . .” First-order beliefs reflect what someone is thinking or feeling, i.e., she thinks that Jose is happy. Beginning around 6–7 years of age children understand second-order false beliefs, which reflect thoughts about thoughts. The following story illustrates a second-order false belief task:

The grandfather hears grandmother tell Johnny that she is taking the baby for a walk to the park. Later, the grandmother returns and tells the grandfather the park was closed and she is instead taking the baby to the beach. Johnny overhears the change in plans, but he is playing out of sight. Consequently, the grandfather does not know Johnny is aware of the change in plans. A little later, Johnny tells his grandfather that he is going to play with the grandmother and the baby.” The child is asked: Where does grandfather think Johnny will go? The correct answer is that the grandfather falsely thinks Johnny will go to the park because Johnny think the grandmother is at the park.

(adapted from Hughes et al., 2000, p. 489)

Second-order task performance shows similar relations to language and executive functioning, as first-order tasks (Miller, 2009).

Theory of mind is measured differently for adolescents because there is a ceiling effect for first- and second-order false belief tasks. Some researchers posit that understanding others’ feelings should be added to the definition of theory of mind, creating both a cognitive theory of mind and an affective theory of mind (Sebastian, 2015). As the importance of social relationships and situations escalate in middle childhood and adolescence, the significance of an affective theory of mind increases as well. Affective (or feeling-based) theory of mind has been positively linked to all three subcomponents of executive functioning (i.e., inhibition, working memory, and cognitive flexibility) with inhibition having the largest effect (Vetter, Altgassen, Phillips, Mahy, & Kliegel, 2013).

Other frequently used higher-order tasks involve the Strange Stories task, Stories from Everyday Life, Faux Pas, The Eyes Test, and variations of recursive thinking loops (Banerjee, Watling, & Caputi 2011; Miller, 2012). In the Strange Stories task, stories center on situations involving pretending, jokes, lies, figures of speech, and irony. These measure more realistic and higher-order theory of mind skills. The Faux Pas task measures false-belief understanding by presenting participants with story lines involving faux pas and by asking a second-order false belief question about the story:

James bought Richard a toy airplane for his birthday. A few months later, they were playing with it, and James accidentally dropped it. “Don’t worry” said Richard, “I never liked it anyway. Someone gave it to me for my birthday.” The participant is then asked a memory question: “What did James give Richard for his birthday?” followed by the false belief question: “Did Richard remember James had given him the toy airplane for his birthday?”

The ability to pass these tasks require second-order false belief abilities and increases with age as the understanding of social situations expands (Baron-Cohen, O’Riordan, Jones, Stone, & Plaisted, 1999).

Theory of Mind in Adulthood

Much theory of mind research has primarily focused on early development, although its development undergoes further refinement in adults as their understanding of mental states becomes more nuanced. Many of the tasks used in adolescence, such as social faux pas, can be applied to the study of adults. Interestingly, much of the research on adult theory of mind comes from social psychology, which focuses on certain biases in attributing mental states to others, similar to what young children show. Some researchers argue, however, that even adults are prone to errors in first-order false-belief reasoning and other theory of mind tasks due to biases that operate across life. According to this interpretation, children’s inability to pass false belief tasks prior to age 4.5 years reflects a cognitive bias, i.e., “curse of knowledge” that exists across the life span but at different levels. Specifically, children fail tests of false belief because they lack the ability to suppress their current knowledge when inferring the knowledge of another (naïve) person.

Adults given an expanded unexpected location task with multiple new locations also exhibit the curse of knowledge bias. Adults who know the true location of a displaced object are more likely to assign a higher search probability to the true location than other possible new locations compared to those who do not know the true location. This bias occurs even though both groups are told that the character has no knowledge of the new location. The probability of search at each location should be the same for naïve adults. Adults who hold privileged knowledge are “cursed” by their knowledge of the correct location, and mistakenly assume that their knowledge is shared by others (Birch & Bloom, 2007; Dumonthiel et al., 2010). More broadly, adults frequently attribute their own private knowledge to others, assuming that others share their likes, dislikes, and perspectives.

The hindsight bias is the tendency to believe we “knew it all along.” Adults who are provided with knowledge “after the fact” tend to attribute that knowledge to naïve others or to their naïve former self. If two groups of adults are asked to guess the true height of the Eiffel Tower, they provide a wide range of responses. Later, when asked to recall their guess, one group is told the correct height (1,063 feet) before recalling their original guess, and the other group is not told the true height. The first group reported being more accurate than the group not provided the correct answer. Individuals will even recall having been “more correct” after being told the correct answer despite being explicitly warned against committing this bias (Bayen, Pohl, Erdfelder, & Auer, 2007).

These biases are reflected in adult perspective-taking tasks. An adult’s initial reaction to directions given by another person are often egocentric, but adults simply correct for this egocentrism more quickly than children do (Epley, Morewedge, & Keysar, 2004). The ability to consider the visual viewpoint of another person increases from approximately age 7 through 27. Participants were able to see certain objects on a set of shelves that were occluded from the view of a confederate “director.” Other objects were visible to both parties. The director asked the participant to move certain objects around the set of shelves. When directed to “move the smallest truck” participants were required to take into consideration that the smallest truck visible to the participant may be occluded from the view of the director. The likelihood of moving objects that were invisible to the director declined with age but was still present in adults (Dumontheil et al., 2010). Similarly, when shown an ambiguous picture, individuals report seeing the object sooner as the picture resolution is made clearer than those who are not told the picture’s identity (Bernstein, Atance, Loftus, & Meltzoff, 2004).

The false-consensus effect occurs when adults expect that others share their beliefs, or that their personal preferences are common to the population as a whole. Early work showed that regardless of actual commonality, individuals are likely to consider their own personal preferences or choices in a variety of situations as “common” to the general public. College students attributed their own level of risky behavior, such as sexual activity, alcohol or drug use, as similar to other college students.

Adults commit several errors that appear to reveal anomalies of their theory of mind competence. Thus, despite being much better at traditional false belief change tasks, adults may not be much better than children when the same skills are required of them in a different type of task. Adults often struggle when recognizing their changes of own knowledge, as well as recognizing that someone else has a false belief.

Neural Bases of Theory of Mind

The relationship between neural processes and cognition (mind) has generated considerable research and controversy, such as how consciousness arises from neural activity (Hickson & Stacks, 2010; Presti, 2016). While these issues regarding the relation between the brain and mind are far from resolved, numerous tests (e.g., functional imaging, electroencephalography, magnetoencephalography, and positron emission tomography) have been conducted to investigate the neural bases of theory of mind reasoning, particularly false-belief understanding. Siegal and Varley (2002) proposed a widely distributed neural system involved in mental-state reasoning, which is comprised of one core system and three co-opted systems. The core system is centered on the amygdala and its interconnections with prefrontal and temporal lobe, whereas the three co-opted systems include the frontal lobe, the right temporal-parietal cortex, and the language-related region in the left hemisphere.

Specific important theory of mind regions raised by other researchers include the medial prefrontal cortex (mPFC), which is recruited when people inferring enduring dispositions and temporary mental states of others and self (Van Overwalle, 2009); bilateral temporo-parietal junction (TPJ), which play a role in identifying the intentions underlying behaviors (Saxe & Powell, 2006); bilateral superior temporal sulci (STS), which help detect the behavior and analyze the outcomes underlying the behavior (Carrington & Bailey, 2009; Gweon, Dodell‐Feder Bedny, & Saxe, 2012); and bilateral temporal poles, which are activated during object and face recognition (Gallagher & Frith, 2003). Some of these regions also are important for executive function (i.e., mPFC; Shallice, 2001) and face processing (i.e., mPFC, TPJ, and STS; Carlin & Calder, 2013). From a developmental perspective, evidence suggests an increasing trend of the functional specificity of right TPJ to mental state attribution during 6 to 12 years (Gweon et al., 2012). That is, right TPJ in younger children responded to both mental and physical reasoning whereas right TPJ in older children as well as adults selectively responded to mental state reasoning.

Consequences of Theory of Mind Development

As a core aspect of social cognition, theory of mind has been linked to both social and cognitive outcomes, including communication, social competence, peer popularity, the ability to resolve conflicts and maintain friendships, school adjustment, literacy, imagination, and academic achievement. These relationships are bidirectional. Not only does the development of a theory of mind contribute to these outcomes, but these cognitive and social experiences affect theory of mind development.

Communication Skills

Communicating with others is central to social interactions. During verbal interactions, people exchange ideas, beliefs, and feelings, creating social bonds with each other. The development of communication abilities has been studied from numerous perspectives, including linguistics, anthropology, and psychology. Communication theorists, for instance, have suggested that communication is strongly impacted by biology (Hickson & Stacks, 2010; Vocate, 2012). Yingling (1994) has argued that the mind develops from social interactions with others. All disciplines recognize that communication requires an understanding of what others want, believe, know, or feel which enables children and adults engage in effective and successful communications. This is reflected through lower frequency of conflict, and higher level of sensitivity during interaction.

Learning language and pragmatic use of language requires the ability to understand others intentional states. If a child hears a new word while an adult speaker is looking at the new object, children will map the new word to the new object. In this scenario, the child interprets the adult gaze as reflecting his or her attentional focus. The child will further assume that the adult is naming a novel object rather than a familiar object that already has a name to maximize communication. This social pragmatic approach to word learning proposes that comprehending the speakers’ intentions is crucial (Gerson & Woodward, 2014). Joint attention exemplifies the role of intentionality in word learning. This occurs when two people, e.g., a child and a parent, are both focused on the same object and each is aware that the other is attending to it as well. Once joint attention is established, both have a “common ground” of shared knowledge that allows communication to occur. Children with ASD are often impaired in this ability to engage in joint attention and their vocabulary development is consequently affected. In fact, they often map words to the wrong object because they are not attending to the speaker’s intended referent.

Referential communication requires that the speaker and listener take into account the others’ knowledge to successfully complete a task, such as retrieving an object or completing a puzzle. The speaker has to adjust his or her messages to take the listener’s knowledge into account. Studies of both children and adults have demonstrated a link between theory of mind and successful communication. Adults with a more advanced theory of mind more effectively adjust their messages to the listener (Achim, Fossard, Couture, & Achim, 2015). However, adults can struggle as well. In an online communication game (similar to referential communication) in which adults need to take the perspective of the listener, adults have problems using what the listener knows to interpret their statements (Apperly et al., 2010).

As the understanding of thinking and mental states expand, children and adults become better at more complex forms of communication. Sarcasm, for example, requires distinguishing between literal and intended meanings. If someone tells an artist that a painting is amazing, she could mean it literally or sarcastically. To provide a sarcastic interpretation, the listener must believe the speaker does not really think the painting is very good which requires a second-order theory of mind. Children can distinguish between the literal and sarcastic meaning of an utterance by around 9 years of age. Individuals with ASD have impairments in communication and other pragmatic language abilities, such as experiencing problems in distinguishing non-literal meanings and typically interpret such sentences as literal (Hale & Tager-Flusberg, 2005).

Persuasion is an important component of everyday communication. It is effective when the speaker considers the listener’s perspective and beliefs. In one study, 3- to 8-year-olds’ persuasive behavior in a naturalistic peer persuasion task was examined. Children had to convince a puppet to do things that he does not like to do, for example, eat raw broccoli or brush their teeth. The creation of persuasion arguments was predicted by their theory of mind performance (Lapierre, 2015; Slaughter, Peterson, & Moore, 2013).

The study of perspective taking has a long history in communication research and is similar to false-belief understanding. Both require the ability to examine the world from another’s perspective. Jean Piaget, one of the most influential developmental psychologists, documented that preschool children are egocentric and have difficulty in taking others’ perspectives. Recent studies have identified two levels of perspective taking. Level 1 perspective taking involves understanding that people see different things. When an actor walks into a room looking for an object, 24-month-olds, but not 18-month-olds, recognize that the actor can see and find the non-occluded object but not the hidden one (Moll & Tomasello, 2006). Level 2 perspective taking involves understanding that two people can be looking at the same thing but from different perspectives (Moll & Tomasello, 2006). Piaget’s three mountain task is a classic measurement of level 2 perspective taking (Piaget & Inhelder, 1956). In this task, a three-dimensional display of three mountains (with various objects placed in different locations on the mountains) is presented to a child who looks at all sides of the display. The child then sits on one side and a doll is placed on the other side and each sees different objects. The child is then asked to pick a picture matching what the doll sees. Children at 4 years of age do not perform well. However, 6-year-olds were able to pick images that were different than their own view, and 7- and 8-year-olds consistently picked the correct photograph (Piaget & Inhelder, 1956). In a recent task, children were asked to manipulate how pictures/objects looked to experimenters by placing them in front of color filters; the filters were different for the experimenter and the child. Three-year-olds recognized that they viewed different colors of the same object (Moll & Meltzoff, 2011).

Perspective taking is related to false belief understanding. Children’s conversational perspective taking, for instance, predicts their later false-belief understanding (Bernard & Deleau, 2007). Similar relations are found between affective perspective taking and false belief. In affective perspective taking, children are told stories about two characters who had similar or different emotional reactions to the same event. False-belief performance was related to affective perspective-taking tasks involving different reactions but not similar reactions to the event (Harwood & Farrar, 2006). Both perspective taking and false belief require understanding that people can have different perspectives and/or beliefs about the same event.

Theory of mind is also related to lying and deception. Lying is typical in development and can be used in both prosocial and deceptive ways. Telling a prosocial lie, for example, to avoid hurting someone’s feelings requires an understanding of second-order false belief (Williams, Moore, Crossman, & Talwar, 2016). Successful lying relies on accurately manipulating others’ beliefs to make them believe something that the liar knows is false. Training can make children more sensitive about others’ beliefs and thus can facilitate the emergence of lying behaviors. While even preschoolers understand that when someone lies they intend for the listener to believe the lie, they cannot deceive someone because they lack second-order belief understanding. The deceiver must remember their initial lie and be consistent in subsequent statements to maintain the deception (Talwar & Lee, 2008).

Peer Relationships

During childhood and adolescence, social relations with peers increase in importance (e.g., friendship, popularity, leadership). Theory of mind understanding facilitates the development and maintenance of friendships through higher frequency of prosocial behaviors and more successful communications during interactions. A meta-analysis of 20 studies including more than 2000 children aged 2–10 years found that theory of mind performance predicted peer popularity in early and middle childhood and that the effect was stronger for girls than boys (Slaughter, Imuta, Peterson, & Henry, 2015). Advanced theory of mind ability is associated with higher levels of peer acceptance and decreases the likelihood of peer rejection (e.g., Banerjee, Watling, & Caputi, 2011). In a two-year longitudinal study, 7-year-olds who had no friends had very poor performance in theory of mind tasks at 5 years of age, even after controlling for age and language (Fink, Begeer, Peterson, Slaughter, & Rosnay, 2015). Peer rejection leads to adverse mental health outcomes such as depressed mood and loneliness, antisocial behaviors such as aggression, school maladjustment, and school dropout. The finding supports the argument that children who have a better understanding of others’ mental states are more socially competent and thus are liked and highly regarded by their peers. Girls are more likely to engage in prosocial behavior.

Intriguingly, advanced levels of theory of mind understanding can lead to negative social consequences as well (Kokkinos, Voulgaridou, Mandrali, & Parousidou, 2016). Bullying behavior, particularly cyber bullying, is a major problem for middle-schoolers and adolescents. According to recent surveys, bullying is experienced by 20% to 24% of students, either as bullies or victims. While numerous factors contribute to bullying, such as poor impulse control and callous emotional traits, it also requires understanding of the mind to manipulate their beliefs and feelings. Poor theory of mind performance at age 5 predicted involvement in bullying in early adolescence (Shakoor et al., 2011). Children with theory of mind insufficiencies may be more likely to morally separate from their actions (Kokkinos et al., 2016). At the same time, young adolescents who are ringleader bullies performed well on a variety of theory of mind tasks (Stellwagen & Kerig, 2013). Theory of mind understanding predicts higher rates of aggressive behaviors and lower rates of withdrawn behaviors for boys.

Risk Taking

Adolescents are particularly prone to engaging in risk taking and reckless behavior. Taking risks is partially due to delayed theory of mind development, along with poor cognitive control ability and heightened sensitivity to sensation seeking. Adolescent decision making may be altered by the inability to inhibit initial reactions to situations, possibly a product of not fully understanding others’ intentions, beliefs, and feelings. In an experimental study of decision making, adolescents made more risky decisions, such as speeding through a railroad crossing in a simulation task, when they thought they were being watched by their friends than when alone. These peer effects were more pronounced for adolescents (aged 13 to 16) than young adults (18 to 22) and adults (aged 24+) (Gardner & Steinberg, 2005).

Adolescents and young adults’ neural activity was measured while asked to make a decision to engage in a risky behavior, such as taking a drug or not. Theory of mind brain regions were activated during risky decision making but were not activated during innocuous decisions, such as deciding what to eat. These effects were stronger in adolescents than young adults (Rodrigo, Padron, de Vega & Ferstl, 2014). In an fMRI study, Peake et al. (2013) found that participants aged 14 to 17 years old showed more bilateral TPJ, mPPC, and mPFC activation during safe decisions. This pattern suggests that adolescents are recruiting these brain regions, associated with mental reasoning, during risky decision making, possibly attempting to understand their peers and make a decision based upon their interpretation.

Learning and Cognition

One of the unique skills of humans is the ability to engage in social learning or cultural learning. Cultural learning includes imitative learning, teaching, and collaboration (Tomasello, 2016). Each type of cultural learning requires understanding mental states. Collaborative learning, for example, requires the coordination of different perspectives, knowledge, and beliefs to arrive at a new solution to the problem. Children who understand second-order false beliefs are able to engage in collaboration (Grueneisen, Wyman, & Tomasello, 2015). Similarly, effective teachers recognize their students’ current understanding of a topic and adjust their teaching accordingly. More broadly, theory of mind development has been linked to academic success. For instance, false-belief understanding and executive functioning in preschoolers, predicted kindergarten math and literacy performance, even after controlling for verbal and fluid intelligence (Blair & Razza, 2007).

A related development is the ability to engage in metacognitive thinking. Metacognition is conscious knowledge about a person’s own mental states and reflects knowledge about his/her cognition. It reflects the ability to “think about thinking” and includes metalinguistic awareness and metamemory. Metacognition is involved in learning and academic success. The relation between theory of mind and metacognition has suggested that having knowledge about the mind helps children to think about their cognition (e.g., Ebert, 2015).

Metalinguistic awareness, the ability to think about languages, is linked to false-belief understanding in preschool children (Guan & Farrar, 2016). In a metalinguistic synonym task children need to pick out the word that has the same meaning of the target word (e.g., target: sofa; synonym: couch). This task requires the recognition that two words can be applied to the same object. Performance on the synonym and false-belief tasks were related (Doherty & Perner, 1998). For both tasks, children need to consider two different representations of the same situation—beliefs and word meaning. Similar effects have been found for metamemory and theory of mind (Lecce, Bottiroli, Bianco, Rosi, & Cavallini, 2014).

Theory of Mind and Intervention for Risky and Health-Related Behaviors

The development of a theory of mind affects both social, cognitive, and behavioral outcomes. Many negative behaviors during development, such as childhood bullying, adolescence risk taking, and adult unhealthy behavior are directly or indirectly related to theory of mind development. One goal of parents, schools, and public health officials is the creation of effective intervention programs to reduce these behaviors. To intervene successfully it is necessary to consider what the target audience believes, as well as their obstacles, such as social-cognitive biases, that must be overcome to alter their behavior. Intervention programs designed to reduce the incidence of these behaviors employ various strategies with varying degrees of success. Many education-based programs focus on changing peoples’ knowledge, such as the incidence of college-student drinking. While these programs are successful in changing knowledge, their effectiveness in changing behavior is more limited (Steinberg, 2008).

Intervention programs that lead to more successful behavioral change use a multiple-component approach. The Fast Track Program to reduce adolescent antisocial behavior focuses on changing social-cognitive processes through social-skills training, parent groups, peer coaching and tutoring (Dodge, Godwin & the Conduct Problems Research Group, 2013). The intervention program is successful in reducing aggression because it lessens the hostile attributional bias (a tendency to attribute hostile intent to others in ambiguous situation), devalues the benefits of aggressive responses, and develops problem-solving strategies for social problems. While this model is framed in a social-cognitive perspective, it clearly reflects a theory of mind view.

Programs that target adult health behaviors have often taken a social psychology perspective. For example, examining whether changing attitudes, such as the importance of seeking out medical tests, influences behavior. These approaches have been applied to a variety of health concerns, such as HIV prevention, reducing the risk of cardiovascular disease, and increasing cancer screening. Increasing the rates of receiving an oral cancer screening among those in rural communities, for instance, is obviously beneficial. Whether individuals are willing to seek out screening is affected by defensive avoidance (not wanting to know the results) and financial resources (Shepperd, Howell, & Logan, 2014). Media campaigns directed at this population can be effective depending on the message and system of delivery (Logan et al., 2015). Messages that focus on fear tend to be less effective compared to those that emphasize reducing stress and anxiety. While these intervention programs with adults do not typically employ a theory of mind perspective, they do target mental states (emotions, beliefs, etc.). More research is needed to investigate whether a theory of mind approach could enhance the development of intervention.

Literature Review

The initial research investigations of theory of mind development focused on the development of false belief understanding during the preschool years. This included the influence of various factors, such as testing procedures, verbal and nonverbal tasks, use of different props (e.g., puppets, actors, story books), and cultural influences. As a meta-analysis demonstrated, the trajectory of false-belief development is not altered by these influences and emerges between 4 and 5 years of age (Wellman et al., 2001).

Subsequent research proceeded in several directions. One research line examined the precursors and predictors of false-belief understanding with the primary focus on the contributions of language (Astington & Baird, 2007), executive functioning (Devine & Hughes, 2014), as well as identifying its neural bases (Saxe & Powell, 2006). Research has also extended the understanding of false beliefs to other ages and to various disordered populations. Interestingly, infants in the second year of life have been credited with an implicit (nonconscious) understanding of false belief. Although the interpretation is not universally accepted, this view is based on infants’ surprise reaction to an actor looking for an object in a new location that the actor does not have knowledge of (Onishi & Baillargeon, 2005). In addition to identifying the earliest evidence of theory of mind, research programs have extended theory of mind across the life span or have examined the development of other mental states, such as emotions, intentionality, and imagination.

Finally, studies have begun to examine the outcomes of theory of mind development for different social and cognitive behaviors. Children with more advanced theory of mind skills generally do better in a social context such as establishing positive peer relationships, although it can also lead to bullying and the manipulation of others. More research is needed to explore some of the implications of theory of mind understanding for creating effective intervention programs for risky behavior as well as optimizing learning across the life span.

Further Resources

The websites listed are research labs that examine social cognition and theory of mind from a neuroscience (Saxe), atypical development (Autism Research Centre), and evolutionary perspective (Max Planck).

Rebecca Saxe Social Neuroscience Lab

Autism Research Centre

Max Planck Institute of Evolutionary Anthropology

Further Reading

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Povinelli, D. D. (2007). On the lack of evidence that non-human animals possess anything remotely resembling a “theory of mind.” In N. Emery, N. Clayton, C. Frith, N. Emery, N. Clayton, & C. Frith (Eds.), Social intelligence: From brain to culture (pp. 393–414). New York: Oxford University Press.Find this resource:

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