It’s well known that people with ASD are often very concrete in their understanding and use of language. That means that when communication is subtle, abstract, or metaphorical, the intent of the message is likely to be missed entirely, ignored or misunderstood.

Unfortunately, most people don’t realize how much of their communication is based upon embedded or hidden messages. There is an implication when we say, “I’m cold” that the person with us will make some suggestion to alleviate that by saying such things as, “Do you want to go inside?” “Do you want my jacket?” “Should I close the window?” just to name a few examples. In fact, it is a skill that develops in most of us by around the age of four.

This concept called Theory of Mind (ToM), was initially identified as a problem area for individuals with ASD in the now classic Sally/Anne study by Simon Baron Cohen, Alan Leslie and Uta Frith. (Initially published in the journal Cognition in 1985 Does the autistic child have a “theory of mind”?)

Although there are a number of games and programs that have been developed to help teach how to read emotions, I believe that it is the teachable moments during a day when this skill most needs to be addressed. To do that, I use a very simply strategy of helping a child see the difference between what is said and what was intended, through the use of speech and thought bubbles. (Based in part on the work of Carol Gray and her book Comic Strip Conversations).

Thought and speech bubbles are used to represent what words come out of a person’s mouth and what words are thought of in a person’s head and demonstrate how these occur simultaneously and are entirely different words. Seeing this drawn out in a concrete way, helps to make the point about what was misunderstood and how to repair the interaction.

Consider a quick example, at the conclusion of a session I recently had with a 13-year-old boy with high functioning autism. His mother and I began to talk as he walked away. He returned a moment later and simply began speaking to his mother. She said, “Do you see I am talking to Diane?” He replied, “yes” and continued to say what was on his mind.

I quickly drew a stick figure with a speech bubble saying, “Do you see me talking to Diane?” and a thought bubble that was empty. I asked this young boy what he thought his mother meant when she said those words. He said, “Did I see her talking to you?” I told him that she had actually meant something different than those words and then drew in the thought bubble, “You’re interrupting and should wait your turn.” His response was a surprised, “Oh!” I explained that his mother’s words were different than her thoughts. Now that he could ‘see’ that and knew what she was thinking, what should he do? He correctly responded, “Wait my turn.”

This was not the first time such a strategy was used with this young boy, nor will it be the last. In fact, his mother commented that she had stopped using the strategy for some time, as he seemed to be doing so much better in regards to social interactions.

This is a strategy that can easily be done and reintroduced into routines at home or school without any major time commitments. It requires no special skill, technology or equipment, can be done anywhere, anytime and makes the point at the moment when it is most likely to be useful for the individual. Once the interpretation of the message is understood, it is important for the person with ASD to apply it and have a positive association to the social interaction. Therefore, I encourage parents and teachers to do a brief role-play to repeat the interaction with the newly acquired information in order to end on a positive note.

photo credit: Lauren Manning