Mentalization (theory of mind) and autism Domina Petric, MD

Mentalization and theory of mind Mentalization mainly concerns the reflection of affective mental states. Theory of mind focuses on epistemic states such as beliefs, intentions and persuasions.

Autism Autism spectrum disorders (ASDs) include: autism Asperger's syndrome pervasive development disorder not otherwise specified (PDD-NOS) Those are neurodevelopmental conditions characterized by core deficits in social communication skills evident before the age of three years.

Interpersonal relationships one's own state of mind state of mind of others Interpersonal relationships involve effective assessment of:

The assessment of one´s own state of mind includes: motivational processes that appraise the value to the self of rewards or punishments as potential consequences of specific social situations real or prospective

The assessment of others´ state of mind includes: mentalizing processes that establish a representation of others' thoughts, desires, goals and beliefs (theory of mind)

The specialized mentalizing-related network involves: temporoparietal junction (TPJ) superior temporal sulcus (STS) temporal pole (TP) medial prefrontal cortex (MPFC)

Temporoparietal junction https://upload.wikimedia.org/wikipedia/commons/4/41/Temporoparietal_junction_diagram.jpg

Superior temporal sulcus https://upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Gray726_superior_temporal_sulcus.svg/640px-Gray726_superior_temporal_sulcus.svg.png

Temporal pole https://upload.wikimedia.org/wikipedia/commons/d/df/Gray726_temporal_pole.png

Stimlab.org http://stimlab.org/wp-content/uploads/2012/05/PrefrontalCortex.jpg

Explicit off-line mentalizing tasks tasks where participants are explicitly instructed to retrospectively explain the state of mind of other people

Implicit on-line mentalizing tasks tasks where participants are not instructed to be involved in thinking about the others during an on-going interaction mentalizing happens in real-time and potentially affects the behavior of the participant him/herself Assaf M, Hyatt CJ, Wong CG, et al. Mentalizing and motivation neural function during social interactions in autism spectrum disorders. NeuroImage : Clinical. 2013;3:321-331. doi:10.1016/j.nicl.2013.09.005.

The reward-related motivation network includes: cortical–basal ganglia circuit nucleus accumbens orbitofronal cortex midbrain dopaminergic neurons

The reward-related motivation network This network is involved in the anticipation and response to both primary and secondary rewards. 

Nucleus accumbens https://static1.squarespace.com/static/52ec8c1ae4b047ccc14d6f29/t/58db89fd1e5b6c6232b387d8/1490782721178/nucleus-accumbens.jpg

Orbitofrontal cortex https://upload.wikimedia.org/wikipedia/commons/f/f6/MRI_of_orbitofrontal_cortex.jpg

Autism spectrum disorders The mentalizing development and reasoning is impaired in individuals with ASDs. Diminished reward valence of social stimuli (faces) leads to reduced attention to these stimuli. The result is abnormal reward processing and deficits in the social interactions and learning. 

Autism People with autism have difficulty understanding goals and intentions of others. Two theories try to explain this: mentalizing theory and the broken mirror theory.

Mentalising theory Only mentalizing network is abnormal. At least basic processing in the mirror system is normal. Many children and adults with autism have particular difficulties with false belief tasks (Maxi´s chocolate task). Failure of implicit mentalizing may be the core difficulty in autism (Frith, 2012). Implicit mentalizing develops over the first two years of life at the same time that autism emerges. Mentalizing remains impaired in high functioning adults with autism.

It is a cause of poor mentalizing. Broken mirror theory Developmental failure of the mirror system is the primary social difficulty in autism. It is a cause of poor mentalizing. Deficits in understanding the kinematic and goal features of an action would lead to further difficulties in understanding emotions and mental states.

The mirror neuron system Mirror neurons are defined as single cells which respond when an individual performs an action and observes an equivalent action. The mirror system seems to match observed actions onto the observer´s own motor system. This system allows action comprehension and imitation from the inside (Rizzolatti, Giacomo, Sinigaglia, 2010).

Literature Assaf M, Hyatt CJ, Wong CG, et al. Mentalizing and motivation neural function during social interactions in autism spectrum disorders. NeuroImage : Clinical. 2013;3:321-331. doi:10.1016/j.nicl.2013.09.005. Wikimedia.org Stimlab.org www.neuroscientificallychallenged.com Hamilton A. Marsh L. Two systems for action comprehension in autism: mirroring and mentalizing. 2013.