Teorija uma dece sa posebnim potrebama

Abstract

Ove godine se navršavaju tri decenije od kada su Premak i Vudraf, dvojica primatologa sa Univerziteta u Pensilvaniji, skovala sintagmu „teorija uma“ kako bi njome opisala sposobnost šimpanzi da sebi i drugima pripišu razlicita mentalna stanja. Ovi autori su smatrali da covek intuitivno razume mentalna stanja drugih osoba. Njihova, tek uzgredno pomenuta zapažanja, da bi bilo zanimljivo ispitati prirodan tok razvoja teorije uma kod skladno razvijene dece, kao i eventualne de$cite teorije uma kod dece sa intelektualnom ometenošcu, inicirala su mnoga istraživanja u poslednjim decenijama XX i prvoj deceniji XXI veka. U našoj sredini tek su sporadicno ra&ena istraživanja iz ove oblasti, pre svega kod skladno razvijene dece i dece sa intelektualnom ometenošcu. Prve, dragocene podatke o razvoju teorije uma kod dece sa poremecajima autisticnog spektra, nalazimo u radovima dr Ivone Milacic-Vidojevic. Ispitivanja teorije uma kod dece oštecenog sluha i oštecenog vida retka su, ne samo u domacoj, vec i u stranoj literaturi, dok se razvojem teorije uma kod dece sa cerebralnom paralizom bavi svega nekolicina stranih autora. Poseban podsticaj istraživanjima u ovoj oblasti dala su otkrica miror neurona cija se funkcija dovodi u vezu sa sposobnošcu razumevanja tu&ih mentalnih stanja; kriticki osvrti na ideju o univerzalnost de$cita teorije uma kod osoba sa autizmom; zanimljiva istraživanja o odnosu razumevanja mentalnih stanja i sposobnosti empatisanja kod osoba s poremecajima ponašanja i, danas vrlo aktuelna, ispitivanja teorije uma kod osoba s traumatskim povredama mozga. U ovoj monografskoj studiji dat je pregled relevantnih istraživanja iz oblasti teorije uma kod dece s posebnim potrebama. Sam koncept teorije uma predstavljen je u uvodnom poglavlju „Teorija uma“, autora dr Branislava Brojcina. Osim prikaza dominantih teorijskih postavki (teorija modula, teorija teorije i teorija simulacije), autor ovog poglavlja pruža nam dragocen prikaz pojedinih etapa u razvoju teorije uma kod neurotipicne dece. Najveci broj radova iz ove oblasti posvecen je poremecajima autisticnog spektra, što je i logicno ako imamo u vidu da je ideja o de$citu teorije

Theory of mind refers to a person’s ability to form representations of other people’s mental states, and to use these representations to understand, predict and judge utterances and behavior. Infant precursors or protoforms of theory of mind knowledge might be found even in the $rst year of life, although most authors suggests that understanding of intentational actions, which takes place in second half of the second year, represents true manifestation of mentalizing ability. In the second year of life children understand that other people have subjective experiences like wishes and emotions. By the age of 3 most children make di*erence between physical and mentalistic worlds. +e majority of studies on theory of mind have focused on changes that take place at around age 4 in normally developing children. At this age, children typically develop a representational understanding of mind, as measured by standard false belief tasks. Between the age of 6 and 7 children realize that people may react in di*erent ways on ambiguous situations. Subtle forms of this ability continue to develop through childhood and adolescence. Concept of the theory of mind, primarily posed by primatologists, 30 years ago, has generated vast array of research, especially in the $eld of autism. Many studies have found that children with autism show speci$c de$cits in theory of mind, and that they perform signi$cantly less well on theory of mind tasks than matched comparison children. In essence, this theory states that individuals with autism fail to impute mental states to themselves and others and that this de$cit manifests as inability to mentalise, or failure to take into account others’ mental states. +e most widely used test of theory of mind is the unexpected transfer test of false belief. It was soon revealed that nearly 20% of persons with autism actually passed tests of false belief, which implies that de$cit of theory of mind might not been universal. In the face of the issue of universality, Baron-Cohen modi$ed his theory by proposing that a theory of mind problem was in fact a delay rather than a de$cit. In order to scrutinize that issue he developed more di.cult second-order false belief tasks. Given that mental age is related with false belief tasks performances some others created advanced tests of theory of mind such as: Strange stories, Eyes Test and Faux Pas stories. It was revealed that even persons with highfunctioning autism have di.culty comprehending non-literal meaning or recognizing emotions by reading information from eyes. Many clinical symptoms of autistic disorder, such as narrow and obsessive interests or repetitive behavior, could not be explained by theory of mind de$cits. +at is why Baron-Cohen has extended this theory to empathizing theory. Empathizing involves the ability to attribute mental states to self and others as well as the ability of having an emotional reaction that is appropriate to the other person’s mental state. A de$cit of empathizing might account for the social and communication abnormalities in autism, while repetitive behavior, obsessions and islets of ability could be assigned to intact systemizing ability. Discrepancy between these two abilities leads us to the conclusion that autism could be described as the extreme form of the male brain. Prevalence and expression of neurodevelopmental disorders might be related to sex di*erences in brain development and prenatal and neonatal testosterone exposures are strong candidates for having a causal role in sexual dimorphism in behavior, including social behavior, and as risk factors for conditions such as autism. In addition, apart from autism, many other disorders occur more o,en in male than in female individuals, including dyslexia, ADHD and early-onset persistent antisocial behavior. +e nature of the relationship between conduct disorders and theory of mind de$cits is still inconclusive. While some authors claim that children with antisocial behavior have de$cits in theory of mind ability, the others argue that, at least in some cases, delinquent children and adolescents do have even superior ability of recognizing other’s mental states. In seminal investigations of the theory of mind abilities Baron- Cohen found that by the age of 4 typical children and children with Down syndrome usually pass $rst-order false belief tasks. In later research it was found that, unlike children with autism, 90 percent of typically developing children (mean chronological age 7.5) passed the second order false belief test, as did 60 percent of the children with Down syndrome (mean verbal mental age of 7.5). One could conclude that the ability of mentalising is almost intact in children with intellectual disabilities. However, more thorough investigations revealed that children and adults with intellectual de$cits do have signi$cant constrains in the development of theory of mind ability. It was also argued that verbal mental age could not be used as a strong predictor of the future development of this ability. Researches in a domain of theory of mind ability in children with sensorial de$cits are very sparse, in spite the fact that this ability is strongly depended upon verbal pro$ciency, which is compromised in deaf and hard of hearing children. In addition, many authors spotted similarities between children with autism and congenitally blind children. Various factors o,en cause delayed or changed motor, cognitive, speech and lingual, and emotional and social development in visually impaired children. It is realistic to expect that the delay will be manifested also in their ability of understanding themselves and other people as beings possessing their own mental world, the world of their own wishes, needs, thoughts, intentions and believes, which we call the theory of mind. +e research $ndings show that there is a delay in visually impaired children in creating the bond with other persons and a delay in understanding social situations which disclose di*erent emotions of other people. According to $ndings of several investigations, including the only research carried out in Serbia, (Jablan, Hanak and Stanimirovic, in press), the blind children had achieved 100 % scores in the theory of mind tasks of the $rst and second levels in the age of twelve years. Just for the sake of comparing, fully sighted children in the age of 4-5 years achieve success in the $rst level tasks (Wellman et al, 2001, according to Cicchetti et al, 2003; Lešnik Musek, 2003), and in the second level tasks in the age of 6-7 years (Lešnik, Musek, 2003). It is interesting that blind children of the same age, at about 12 years, achieve remarkably good scores at solving the third level theory of mind tasks, and, in the age of 13, they achieve the plateau in developing the ability of recognition of the faux pas (Jablan, Hanak and Stanimirovic, in press). We can conclude that, in comparison to the fully sighted children, the blind ones manifest the longest delay in development of theory of mind of the $rst level, while delays in development of the higher levels are ever less. In our opinion, there are direct and indirect consequences of visual impairment responsible for the delay in the theory of mind acquisition, as well as in the acquisition of the earlier nonverbal forms of intersubjectivity. Furthermore, the delay in development of prelinguistic forms of intersubjectivity, which are considered to be a direct predecessors and the ground for developing the linguistic ones, (Meltzo*, 1985, 1990 and Trevarthen, 1980 and 1998, according to Beebe et al, 2005; Stern, 1985), could be of special signi$cance for understanding the delays of the blind children in the theory of mind development. As we could see, in relation to the fully sighted children, the longest delay in development of the theory of mind in the blind children is concerning its basic, $rst level. Direct consequences may appear because of the insu.cient experiences of cross-modal contingency (Meltzo*, 1990, according to Beebe et al, 2005), whereby the lack of visual information is obviously critical. Namely, we assume that, in the blind children, there is not enough stimulation of the mirror brain areas, which enable the recognition of the states and intentions of others (Carr et al, 2003; Meltzo* i Gopnik, 1993, Tomasello, 1999, all in Beebe et al, 2003). +e next direct consequences could be the absence of the imitation of the facial expression, which is also a channel for understanding the mental states of others by the autonomous responses, which are generated by the facial expression characteristic in particular emotional states (Ekman, 1990, 1993; Dimberg et al, 2000). +e indirect consequences are referred to all obstacles in the direct mother-child interaction, which, consequentially lead to disturbed or poor contingency and the tracking of the interaction participants. +ese obstacles maybe due to the uninformed parents about the ways the visual impairment a*ects the child’s displaying the needs, especially the needs for interaction; due to rejection of child’s disability, and/or the parents’ trauma, who have got a disabled child. Within the domain of the parentchild verbal communication, the use of the mentalistic terms can be of crucial relevance. +e investigation of Mains et al, (2002), has shown that mothers, who saw their children as capable of intentional acts, will response more sensitively and more adequately to the child’s needs, will be motivated to understand child’s behavior, and they will more frequently use the mentalistic terms in their interaction with the child. +e children, whose mothers used more mentalistic terms in the interaction in the age of six months, were more successful in the test battery for the theory of mind testing in 45-48 months age! Although there are no similar investigations of parent/visually impaired child interactions, the investigation of Roch-Levecq (2000) indicates that the visually impaired children are poorly involved in the forms of conversation in which the participants spontaneously talk more about mental states of other people. Growing theoretical value is lately being ascribed to the question whether the inability of grasping the concept of false belief is limited to autism or whether it includes some other categories of developmental disorders. Research results point to a category of children, which appear to have the same extended delay in deductive theory of mind skills, as autistic children do. +ese are hearing impaired children which unlike autistic children, have no CNS disorder. Hearing impairment is usually caused by a lesion localized in the inner ear. Results of di*erent studies show that acquisition of theory of mind in hearing impaired children could depend on the nature and length of conversation within the family, during early childhood. +ree di*erent groups of hearing impaired children can be identi$ed based on their participation in either verbal or gestural communication with family members. +e $rst group consists of children who live with hearing impaired parents and develop early rich gestural communication. +e second group consists of hearing impaired children who have acquired oral language through implementation of an auditory method and hearing aid, resulting in the use and understanding of speech within their environment. +e third group consists of hearing impaired children who were not educated for oral speech and who have acquired sign language as late as the school period, since their family was not trained to use gestural communication. Hearing impaired children who have used sign language since early childhood and those who successfully acquired oral communication show a signi$cant di*erence in success in the false belief tasks, when compared to their hearing impaired peers who have not acquired oral communication and whose families have not been trained in the use of gestural communication. Hearing impaired individuals who have been using oral or gestural language since early childhood, manage to develop the concept of false belief at the same age as hearing children. However, hearing impaired children who had not acquired oral communication and started with late use of sign language instead, systematically show poor results in false belief tasks (Courtin and Me1ot, 1998; Peterson and Siegal, 1999). +ese di*erences are not transient in nature, but permanent, and can be followed at ages from 5 to 16 years (Peterson, Siegal, 1999; Russell et al., 1998). Even when hearing parents employ great e*orts in learning to communicate with sign language, the result is o,en discouraging. Vaccari and Marschark claim that over 90% of hearing impaired children have hearing parents and a signi$cant number of these parents are either unfamiliar with gestural communication or know the skill poorly. In such cases, it is recommended for the children to be included in early auditory training in order to acquire oral language, since this single mode of communication can help them achieve well-developed cognitive processes within their hearing families.+e reviewed research leads to a general conclusion that development of speech and language and the skill and possibility of using speech are crucial for communication within families and could have a central role in understanding mental processes. At least, but not at last, we should stress that children with cerebral palsy also have many constrains in the development of theory of mind abilities. It is seemed that only 25% of these children with signi$cant language disorders pass false belief tasks of the $rst and the second order. Development of mentalizing ability in these children is rather delayed than abnormal. +ese $ndings could be interpreted by lack of social interactions, poor social experience, constrain capacity of working memory and localization of the brain injury. In the last few years some authors made an e*ort to investigate theory of mind ability in persons with traumatic brain injuries. It seems that bifrontal lesions signi$cantly contribute to the loss of previously well developed theory of mind, although the results on relation between this ability and executive functions are still to be scrutinized.