This last December, I was happy to receive a Christmas video of a dear family that showcased their autistic son (let’s call him Andy). A few years ago, during the span of one Summer, Andy participated in one of our transcranial magnetic stimulation (TMS) trials. I grew close to the family and I enjoyed showing them around our small city. Ever since, we have kept in close contact. The Christmas video portrayed events at a talent show at Andy’s school. Although Andy is incredibly talented, he had been quite nervous in anticipation of the show. You see, Andy was motivated to participate as a way of obtaining social approval. Unfortunately, the outcome he desired clashed with the way he evaluated himself. Despite his talents, Andy suffers from low self-esteem.
There is a theory in personality research called self-verification. According to this theory, people are motivated to maintain a consistency between their actions and their own beliefs. Once you see yourself as a certain person, you are motivated to act in a way that maintains those expectations. When they behave in a manner inconsistent with their beliefs, the resultant dissonance procreates maladaptive behaviors. In this regard, Andy is prone to temper tantrums and acting in a childish manner, well below his chronological age.
People with low in self-esteem are less satisfied with their life and grow to have many health issues, including problems with alcohol abuse. I believe that many autistic individuals are unsatisfied with many aspects of their lives. They are less able to cope with daily life problems and act in ways that ultimately are unsatisfactory to them. They savor negative instead of positive emotions. I have to wonder how much does this negative affectivity contributes to poor health, a poor immune response, and whether it even lowers longevity. Indeed, life expectancy in autism is about 54 years of age, way lower than in the general population.
People with positive affectivity are open to try different things in their lives and, as a result of trying, they develop a wider set of skills. People with negative affectivity don’t try as much. However, when they find the one thing that they do like, they tend to invest more time practicing the same and developing deeper knowledge.
Differences in our emotional baggage distinguish each one of us as individuals. Emotions are a reflection of the way we answer threats and opportunities. A person requires some theory of mind in order to understand how specific circumstances may affect them, and how that individual appraises the given situation. Going back to Andy, he obsessively wondered how participating in the talent show would affect him. The fact that Andy was exceedingly anxious about his participation argues against the theory of mind concept in autism. Theory of mind is the ability to attribute mental states to others and to oneself. Some researchers claim, but I disagree, that it is a core abnormality of autism.
The emotional reaction to a future threat is anxiety; alternatively, the acute reaction to a threat is fear. Social anxiety/fear is caused by how we perceive how other people are evaluating us unfairly or negatively. This is also a reflection of our own social skills. I do believe that deficits in theory of mind have been confused with deficits in social skills and the implementation of inadequate testing paradigms. How easily do you get embarrassed? How would you feel if you dropped to the floor a tray of shrimp at a fancy dinner party? Autistics are mortified and feel afraid of performing in situations where they might be embarrassed. This emotional state, feeling mortified and afraid, requires that you judge the mental states of others around you.
Autistics have theory of mind because many of their behaviors are dictated by what they appear to expect from social norms. I have seen patients nervously participating in talent shows, doing stand-up comedies, and even debating philosophy, all of which would tend to negate the theory of mind construct of autism. They do however share in certain personality traits. They have low curiosity and are less keen to diversify their perceptual experiences, to taste foods and try different clothes and textiles. They do not tolerate ambiguities and want to be certain in regards to possible outcomes. They want definitive answers to questions and, in the same way, have concrete answers to questions. Once they take a decision, that is where they will stand; no need to go back and revisit the problem. Personality differences elucidate a lot about how autistics think and behave; theory of mind deficits adds little to the conversation.
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Casanova MF. Autism Updated: Symptoms, treatments, and controversies. Amazon Publishing, co, 2019.