perspective-taking ability and its relationship to the social behavior of autistic children

Journal of Autism and Developmental Disorders, Vol. 17, No. 4, 1987

Perspective-Taking Ability and Its Relationship to the Social Behavior of Autistic Children I

Geraldine Dawson z and Margaret Fernald University of North Carolina at Chapel Hill

A study was undertaken to assess the relationship between perspective-taking ability and the quality o f social behavior in autistic children. Sixteen autistic children ranging f r o m 6 to 14 years o f age were administered three types o f perspective-taking tasks (perceptual, conceptual, and affective), as well as the Peabody Picture Vocabulary Test and the Leiter International Perfor- mance Scale. Two measures o f social behavior were taken: the Vineland So- cial Maturity Scale and the Social Behavior Rating Scale, designed f o r the present study. It was f o u n d that perspective-taking ability was significantly correlated with both measures o f social skills, whereas receptive vocabulary and nonverbal intelligence were not. These results suggest that the social impairments o f autistic children may be related to specific deficits in social cognition.

The impai rments of autistic chi ldren appear to extend beyond language, per se, to include cognitive deficits (Bartak, Rutter , & Cox, 1975). The exact nature of these deficits is unspecified, a l though the general capacity for use of symbols tends to be affected (Dawson & Adams , 1984; H a m m e s & Lang- dell, 1981; Ricks & Wing, 1975; Ungerer & Sigman, 1981). Cur ren t research on the role of cogni t ion in social and emot iona l development may be useful

~We are grateful to the autistic children who participated in this study, and to the teachers and staff of the TEACCH Division, University of North Carolina, for their cooperation and useful feedback on the design and manuscript. Mary Evers assisted in data collection, Larry Galpert provided helpful suggestions on the manuscript, and Sue Wilson provided secretarial support. This study was based on a master's thesis completed at the University of North Carolina by the second author. Financial support was provided by the University of North Carolina Research Council.

2Address all correspondence to Geraldine Dawson, Department of Psychology, NI-25, Univer- sity of Washington, Seattle, Washington 98195.

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0162-3257/87/1200-0487505.00/0 �9 1987 Plenum Publishing Corporation

488 Dawson and Fernaid

for understanding the nature of the cognitive deficits found in autistic children and how these deficits may be related to their lack of social related- ness. In the present study, the possibility that perspective-taking ability may be related to the quality of social behaviors in autistic children is explored.

A profound and general failure to develop social relationships is a fundamental characteristic of autism. In later childhood, there may be some improvement in social relationships, but there still tends to be a general lack of cooperative group play and a failure to naturally develop persisting friend- ships (Rutter, 1974). A few may become "somewhat outgoing," but in general shallow affect and lack of empathy persist (Rutter, 1970). Among those adolescents with better social judgment, it has been clinically observed that the improvement in social skills seemed to follow the development of a degree of self-awareness-that is, an awareness of their own "peculiarities" (Kan- ner, Rodriguez, & Ashenden, 1972; Rutter, 1974). Such awareness of how they appear to other people implies that these better-adjusted individuals have become able to understand other people's perceptions and viewpoints.

The importance of the ability to take the perspective of another person for social development was originally emphasized by Mead (1934). Piaget's theoretical formulation of perspective-taking has led to several studies of the development of this ability and its relationship to social interaction in both normal (Iannotti, 1978; Krebs & Sturrup, 1974; Marcus, Tellen, & Roke, 1979; O'Connor, 1977; Yarrow & Waxier, 1976; Zahn-Waxler, Radke- Yarrow, & Brady-Smith, 1977) and atypical (Affleck, 1976; Bender & Carl- son, 1982; Chandler, Greenspan, & Barenboim, 1974; Leahy, Balla, & Zi- gler, 1982; Marsh, Sarafica, & Barenboim, 1980; Waterman, Sobesky, Sivern, Aoki, & McCauley, 1981) populations. With few exceptions (e.g., Zahn- Waxier et al., 1977), a positive relationship between perspective-taking and interpersonal skills has been found. Of particular interest with respect to autistic children is the recent finding by Waterman et al. (1981) that, with mental age partialed out, inferior perspective-taking ability in emotionally disturbed children was associated with higher levels of social withdrawal. Waterman et al. conclude that "poor understanding of social interaction may discourage participation in such interactions" (page 145).

A variety of tasks has been used to assess perspective-taking abilities. In each task, the child is asked to make an inference about another person's perspective. The inference may pertain to the other person's visual perception of the environment (perceptual role-taking), to his or her thoughts and intentions (cognitive role-taking), or to his or her feelings and emotional states (affective role-taking, also referred to as empathy). Correlations among the various types of perspective-taking ability, as well as among responses to different tasks that assess a specific type of perspective-taking skill, are fre- quently low or inconsistent across studies (Borke, 1975; Coie, Constanzo,

Perspective-Taking in Autistic Children 489

& Farnill, 1973; Kurdek & Rodgon, 1975; Nigel & Fishbein, 1974; Marvin, Greenberg, & Mossier, 1976; Shantz, 1975, Van Lieshout, Leckie, & Van Sonsbeek, 1976). Despite these inconsistencies, the general notion that children become more aware of the perspectives of others during early childhood is still supported (see Houssiadas & Brown, 1980, for review).

Hobson (1984) assessed the visual perspective-taking abilities of autistic, mentally retarded, and normal children who were matched on independent tests of cognitive ability. He found that autistic children were not selectively impaired in visual perspective-taking; they performed as well as the comparison groups did on these tasks. In fact, 8 of the 12 autistic children performed without error. The latter finding suggests the possibility of a ceiling effect; that is, this particular sample of high-functioning autistic children may have been too advanced in their abilities for the tasks to dis- criminate well either among or within groups. Hobson raised the possibility that perspective-taking deficits were a feature of earlier phases of development, and may have played some role in distorting these children's socializa- tion. However, he views this as an unlikely possibility and concludes that "the studies to date provide little evidence for a relationship between the social disabilities of autistic subjects and their performance in tests of coordination of perspectives. The cognitive functions that these tasks involve are unlikely to have an important bearing on the autistic child's social handicaps" (page 103). The present study does not address the question of whether autistic children are particularly susceptible to impairments in perspective-taking, a question addressed by Hobson's research. Instead, it addresses the question of whether there exists a positive relationship between perspective-taking ability and the interpersonal skills of autistic children.

Tasks that measure perceptual, cognitive, and affective role-taking ability were administered to a group of autistic children who varied in chronological age, general intelligence, and language ability. Each of the tasks had been used in previous research on perspective-taking abilities with normal children. From the wealth of possibilities, tasks were chosen that reflected the strongest developmental discrimination within the 3- to 8-year age range given the prior information that the mental ages of the children in this study were in this range. In addition, in light of the particular communication problems of this population, tasks were chosen for simplicity of verbal instructions and for minimal dependence on verbal responses. Receptive vocabulary and nonverbal intelligence were also assessed. Two measures of social ability were used, each of which has advantages and disadvantages. The first measure was the Vineland Social Maturity Scale (Doll, 1953). The measure has the advantage of perhaps being the most widely known and widely used device for the assessment of social competence, and also of being standardized and reliable. However, it contains some social items that are

490 Dawson and Fernald

of a general nature, such as dressing and eating, which may not bear directly on the specific social handicaps of autistic children. The second measure, the Social Behavior Rating Scale, was designed by the present authors to help alleviate this problem. While only informal measures of reliability and validity were taken for this scale, it does focus more specifically on the social behaviors that constitute social relationships, such as initiating and sustain- ing play with others, sharing, and so on.

The present study addressed three questions: (1) Is the social behavior of autistic children related to their general perspective-taking ability? (2) Among the types of perspective-taking tasks (perceptual, cognitive, and affective), is performance on one most highly predictive of autistic children's social abilities? (3) Is the social behavior of autistic children more closely related to perspective-taking ability than to measures of general intellectual functioning?

M E T H O D

Subjects

Sixteen autistic children, 4 females and 12 males, participated in this study. Chronological age ranged from 6 years 1 month to 14 years 7 months (,~ -- 11 years 1 month). Mental age, as measured by standardized intelligence tests (Stanford-Binet, WISC-R, or Merrill-Palmer) ranged from 3 years 6 months to 8 years 3 months ( ,~ = 5 years 8 months). Subjects were recruited from the TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped CHildren) Program, Department of Psy- chiatry, University of North Carolina. All subjects were currently enrolled in TEACCH classrooms for autistic children. They were screeneed by inter- views with their teachers to ensure that they could meet the language and attentional demands of the experimental procedure.

Diagnosis of autism was established for each subject on the basis of an interdisciplinary diagnostic evaluation carried out by staff at Division TEACCH. Diagnosis was based in part on the results of the child's score on the Childhood Autism Rating Scale (Schopler, Reichler, DeVellis, & Daly, 1980). All children met the DSM-III diagnostic criteria for early infantile autism.

Materials and Task Procedures

Perceptual Role- Talcing

Five subtests based on tasks used by Flavell, Botkin, Fry, Wright, and Jarvis (1975) and Zahn-Waxler et al. (1977) were administered. For each of


these subtests, the child and the experimenter were seated opposite each other at a table.

Upside Down. Preliminary to this task, the experimenter came around to the child's side of the table to ascertain his or her understanding of the term upside down, "standing on his head," or an equivalent phrase if used by the child spontaneously. Once the child's understanding had been established, the experimenter returned to her seat to begin the task. A card, with a black-and-white line drawing of a boy standing up, was placed crosswise between the child and the experimenter. The child was asked to show the boy to the experimenter so that the experimenter could see him standing on his head. If the original response was incorrect, the experimenter told the child that it did not look right and the child was allowed a second trial. The child received 2 points for a correct initial response, 1 point for a correct second response.

Face. A line drawing of a face was placed crosswise between the child and the experimenter. The child was asked to place the picture so that the boy was looking at the experimenter. Again, the child was informed if his or her response was incorrect, and given a second trial, if necessary. As in the first task, 2 points were given for a correct initial response, 1 point for a correct second response.

Spontaneous. Three sets of two picture-cards each were used. The pictures were simple colored drawings of children playing. Cards were presented one set at a time, oriented right side up for the child. The child was asked to choose one and show it to the experimenter. A response was considered correct if the card was shown right side up to the experimenter. If the spontaneous orientation was incorrect, the child was allowed a second trial. Again, the child received 2 points for a correct initial response, 1 point for a correct. second response.

Cubes. Two identical 6-inch cubes were used. A different picture was on each of the four vertical faces. The pictures were of a dog, a ball, a tree, and a chair. One cube was presented to the child for learning purposes. Dur- ing the learning procedure, the child walked around the cube to view and name each of the pictures. After the child demonstrated that he or she had memorized the relative positions of the pictures, the second cube was presented, and the task was begun. The experimenter rotated one cube, ran- domly presenting a different face to the child for each of the four trials. Each tim% the child was asked to turn the other cube until the child could see the same thing on his or her cube that the experimenter saw on her cube. The child received 1 point per trial for a correct response.

Single Cube. After the four trials with both cubes were completed, one cube was removed. The experimenter then rotated the single cube at ran- dom, again presenting a different face to the child for each of four trials. Each time, the child was asked to name first the picture that he or she could see, and then the one that the experimenter could see. Scoring was based on the response to the experimenter's perspective, 1 point per trial.


Conceptual Role-Taking

Two subtests were administered. These subtests were also based on tasks used by Flavell et al. (1975) and Zahn-Waxler et al. (1977).

Gifts. Materials consisted of a necklace, a necktie, a doll, a toy truck, and a book. These were placed in front of the child, who was asked to choose one as a "gift" for mother, father, sister or brother (or friend), and self, in turn. Scoring was based on responses to all except the last (self). One point was received for each age-appropriate choice.

Chairs. Four chairs were placed in a row, two adult-sized and two child- sized alternating. The child was asked to pick the chair for the experimenter, for a child (friend's name was given), for an adult (teacher's name was given), and for self. The child received 1 point for each appropriate response to the first three persons.

A ffective Role-Taking

This task was previously used by Borke (1971), from whom the materials were obtained. Drawings of four faces--happy, sad, afraid, and a n g r y - were first presented to the child to establish his or her ability to recognize and name the emotions since this was necessary for performing the task. Faces were appropriate to the child's gender and race. A practice trial was given to teach the child the appropriate matching response for the task. All children were able to perform this prerequisite trial.

In Part I, the child was shown a series of pictures of another child with a blank face in various situations that would typically elicit one of the above emotional responses (e.g., receiving a present, falling down and hurting one- self, being alone in the dark). With each picture the experimenter gave a short description of the situation (a simplification of Borke's original stories). The child was then asked to pick the face that showed how the child in the picture felt.

In Part II, the child was shown one picture of a faceless child, who was identified by the name of one of the child's friends or siblings. A series of incidents was described in which the child and his or her friend (or si- bling) were interacting. The child was then asked to choose the face that showed how the other child felt in that situation. The child received 1 point for each correct response in Parts I and II.

Combined Perspective- Taking Ability

A score was obtained by adding the perceptual, conceptual, and affective role-taking scores for each child. This provided a score of general perspective-taking ability.

Perspective.Taking in Autistic Children 493

Measures o f General Intellectual Functioning

The Leiter International Performance Scale was administered as a nonverbal measure of general intelligence. The Peabody Picture Vocabulary Test (PPVT) was given as a measure of receptive vocabulary.

Social Behavior

Social age scores (in months) from the Vineland Social Maturity Scale were used as one measure of social competence. Th e second measure was the Social Behavior Rating Scale, which assessed social abilities along several dimensions. Each child's teacher was asked to rate him or her on a 7-point scale for each of the following dimensions: proximity (ranged from "almost always plays alone" to "almost always plays with others"), quality o f social play (ranged from "does not play with others" to "typically engages in recipro- cal play"), initiative (ranged from "almost never spontaneously invites others to play" to "almost always invites others to play"), responsiveness (ranged from "almost never joins in an activity even with encouragement" to "almost always responds to others' invitations to play"), sharing (ranged from "almost never shares materials with others" to "almost always shares materials"), avoidance (ranged from "almost always abandons an activity when others join in" to "almost never leaves an activity when others join in"), sensitivity to social cues (ranged from "typically does not make eye contact with others" to "uses a wide variety of nonverbal cues"), and play complexity (ranged from "does not play with others" to "plays in complex rule-governed games"). Note that no verbal items are included in this scale. The social skills assessed by this questionnaire are relevant to the age range from infancy to approximately 8 to 10 years. Thus, given that some of the subjects were adolescents, a perfect score could be obtained when social deficits were present. However, no child obtained a perfect score. The Social Behavior Rating Scale can be obtained from the authors upon request.

Teachers were asked to rate each child in absolute terms rather than relative to their chronological age, or to other children in their class. Each teacher who participated in this study rated approximately 3 or 4 of the children, all of whom were of similar chronological ages.

Informal ratings of the social behavior of each child were also made by the experimenter. These ratings corresponded well to the teacher's ratings, thus adding external validity to the scale.

The relationship between perspective-taking ability and severity of autistic symptoms was also of interest. Recent Childhood Autism Rating Scale (CARS) scores were available for the subjects. These scores are based on an assessment of the severity of specific autistic symptoms (e.g., lack of eye contact, echolalic speech, motor stereotypes, insistence on sameness). On the basis of this score, judgment from mild to severe autism can be made.

494 Dawson and Fernaid

Procedure

Each child was seen individually at his or her school, in a quiet and usually familiar room. Testing sessions were scheduled in the morning. Each lasted approximately an hour and a half, during which the child was given the role-taking tasks, the Leiter, and the PPVT, which were counterbalanced for order of testing. Within this sequence, the perceptual, conceptual, and affective role-taking tasks were also counterbalanced. Reinforcers such as stickers and praise were given for cooperation with the experimenter.

RESULTS

Table I displays the range, mean, and standard deviation for each of the seven predictor variables, as well as for the two measures of social behavior and CARS scores. The fact that the Leiter MA ranged from 3 to 8 years and the Vineland Social Age Scores ranged from 3 to 7 years suggests that both the perspective-taking tasks and the Social Behavior Rating Scale were appropriate for the ability levels of these children. Data were analyzed using Spearman Rho rank-order correlations. The correlations between each of the major predictor variables, perspective-taking ability, Leiter MA, PPVT MA, and CA, and the two measures of social behavior and CARS scores are shown in Table II. Perspective-taking ability most consistently predicted level of social behavior. Perspective-taking ability was significantly correlated with both measures of social behavior, as well as with the severity of autistic symptoms, as measured by CARS scores. Neither measure of social behavior was found to be correlated with PPVT MA, Leiter MA, or chronological

Table I. Descriptive Statistics for Role-Taking Ability, Leiter MA, PPVT MA, and Measures of Social Behavior

Range Mean SD

Predictor variables ~ Role-taking-- total score (45) 12-33 21.0 6.5

Perceptual (18) 1-14 7.8 3.9 Conceptual (11) 3-11 7.4 2,5 Affective (16) 1-9 5.8 2,9

Leiter MA b 3-6-8-3 5-9 1-6 PPVT MA b 2-6-9-5 4-9 2-3 Chronological age b 6-1-14-7 11-1 2-2

Social behavior Vineland Scale b 3-6-7-1 5-5 1-0 Social Behavior Scale (56) 17-49 32 10,8 CARS scores 25-39 30 3,0

aNumber in parentheses indicates max i mum possible scores. bAges are given in years and months .


Table II. Rank-Order Correlations Between Perspective- Taking Ability, Leiter MA, PPVT MA, and CA and Meas-

ures of Social Behavior

Social behavior

SBRC a Vineland CARS

Perspective-taking .57 c .47 b .48 b Leiter MA .30 .37 .29 PPVT MA - . 16 .35 .67 ~ CA .38 .31 .41

aSocial Behavior Rating Scale. bp < .05. Cp < .01. ~p < .005.

age. P P V T M A was f o u n d to be significantly related to C A R S scores, however.

Given that perspective-taking ability was found to be related to social skills, separate analyses o f the relationships between each type o f perspective- taking skill and social behavior were carried out. Conceptual role-taking was found to be most consistently related to social behavior and severity o f autism. Significant relationships were found between conceptual role-taking and the Vineland Social Matur i ty Scale (r = .48, p < .05), and C A R S scores (r = .68, p < .005). The relationship between conceptual role-taking and scores on the Social Behavior Scale approached statistical significance (r = .68, p < . 10). Perceptual role-taking was significantly related to scores on the Social Behavior Scale (r = .43, p < .05); a t rend toward a relationship between perceptual role-taking and scores on the Vineland Social Matur i ty Scale was found (r = .40, p < . 10). Affect ive role-taking was not found to be significantly related to either measure o f social behavior. However , a significant correlat ion between affective role-taking and C A R S scores was found (r = .42, p < .05).

The degree to which each o f the perspective-taking measures contributed independent in fo rmat ion was determined by Spearman Rho correlations a m o n g the three variables, perceptual, conceptual , and affective role-taking. None o f the correlat ions a m o n g the three perspective-taking variables was found to be significant (r's = .35, perceptua l /conceptua l ; . 11, perceptual /affective; and .38, conceptual /affect ive) .

D I S C U S S I O N

In the present research, perspective-taking abilities were found to be related to bo th the quali ty o f social behavior o f school-aged autistic chil-


dren and the severity of autistic symptoms. Furthermore, perspective-taking ability was found to be a better predictor of level of social skills than were measures of receptive vocabulary and nonverbal intelligence. Although this cannot be taken as evidence of a causal link between perspective-taking and social behavior, these results do suggest a close linkage of these two abilities, which may be mediated by a third factor such as social interest. Among the three types of perspective-taking tasks, conceptual role-taking was found to be most consistently related to social behavior and autistic symptoms. In Hobson's (1984) study, only perceptual role-taking was studied. Compari- sons of autistic and mentally retarded children's ability to solve conceptual and affective role-taking tasks would be of particular interest. It is more likely that these abilities are involved in developing social relationships than are perceptual role-taking skills.

Affective role-taking was not found to be related to social skills but was related to severity of autistic symptoms. This lack of association may have been due to the fact that this task clearly was the most difficult for the children and produced the smallest range of responses. Whereas some children obtained either perfect or close to perfect scores on the perceptual and conceptual perspective-taking tasks, the highest-scoring child received only 9 out of 16 possible points on the affective task. This is interesting in light of the fact that all three types of tasks are achieved at about the same age in normal children. It is likely that the identification of emotions and empathy are particularly difficult for autistic children, reflecting general problems in the use of human facial cues and other nonverbal communica- tive information (Langdell, 1978). It is also quite likely that this task's more complex verbal instructions and use of abstract, representational rather than concrete materials (i.e., pictures) account for the children's poor performance.

Clinical evidence (Mesibov, 1986) suggests that autistic individuals do have difficulty adjusting their own behavior to relate to what another person is doing, thinking, or feeling. They seem unable to monitor the impact of their own behavior on others, and they often appear insensitive to needs of others (for example, in conversations). Studies of nonautistic children (e.g., Chandler et al., 1974; Marsh, Serafica, & Barenboim, 1980) have found that specific training of perspective-taking skills can have positive effects on children's social abilities and interpersonal problem solving. Mesibov (1986) has found that, with autistic individuals, a more effective approach is to teach autistic persons specific behaviors that help them to monitor the feelings of others; for example, the autistic person can be taught to ask whether the conversation partner is interested in what he or she is saying.

The deficits in perspective-takings skills seen in autistic children may be related to the more fundamental impairments in motor imitation and social and imaginative play that have been found in these children (Curcio,


1978; Dawson & Adams, 1984; DeMyer et al., 1972; Riguet, Taylor, Benaroya, & Klein, 1981; Ungerer & Sigman, 1981). Wolf and Gardner's (1981) research with young normal infants and children suggests that a rudimentary understanding of the roles that persons and objects assume in events is derived from early social interactions, involving imitative and imaginative play. It is further suggested that this process, termed role structuring, provides the foundation for symbolic representations of experience. The failure of autistic children to develop the capacity for role structuring would conceivably undermine not only the development of symbolization but also their perspective-taking ability.

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