theory of mind and cerebral visual impairment...•developed by baron-cohen, leslie & frith...
TRANSCRIPT
TheoryofMindandCerebralVisualImpairment
SomereflectionswithJohnRavenscroftandAmandaLueck
Withthanksto
• AmandaLueck (Prof- Education)• GordonDutton (Prof- Ophthalmology• KarenGoodall (Dr- Psychology)• MartinToye (Dr- Psychology)• LeaHyvärinen (Prof– Ophthalmology)• HelenStClairTracy(ParentofchildwithCVI)• SimonHayhoe (Dr– Education)
Whatisthistalkabout……….?
• GoodQuestion
• MyideasandramblingsaboutCVIandTheoryofMind(TOM)andthenatureofrepresentation
• IwilllookatwhatisToM astryandconnectthistochildrenandadultswithCVI
• Imaybeentirelywrong– partiallywrong– partiallyright– entirelyright
• Buttheissueis– nooneknowsforsure– especiallyme!
TheNatureofRepresentation• “Whatisitliketobeabat”(Nagel1974)• Anorganismhasconsciousmentalstatesifandonlyifthereissomethingthatitisliketobethatorganism– somethingthatitislikefortheorganismtobeitself.
• themind-bodyproblemisnotjustalocalproblem,havingtodowiththerelationbetweenmind,brainandbehaviourinlivinganimalorganisms,butthatitinvadesourunderstandingoftheentirecosmosanditshistory.(Nagel,2012:P.3)
AQuestiontoJohnLocke
Amanbeingbornblindandhavingaglobeandacube,nighofthesamebigness,committedintohishand,andbeingtaughtortold,whichiscalledtheglobeandwhichthecube,soaseasilytodistinguishthembytouchorfeeling;thenboththingstakenfromhim,andlaidonatable.Letussupposehissightrestoredtohim;whetherhecould,byhissight,andbeforehetouchthem,knowwhichistheglobeandwhichthecube?Sowhetherhecouldnotreachthemthoughtheywereremoved20or1000feetfromhim?
• LetterfromWilliamMolyneux toJohnLocke,7thJuly1688.FromthecorrespondenceofJohnLocke,TheJohnLockeCollection,BodleanLibrary,OxfordUniversity.
• SpecialthankstoSimonHayhoetakenfromClassicPhilosophiesonBlindnessandCross-ModalTransfer,1688-2003InRavenscoft (2019)HandbookofVisualImpairment:SocialandCulturalResearch.Routledge.
AnAnswerforJohnLocke
• Whenhewasjustoutofthehospital,andhisdepressionwasbutoccasional,hewouldsometimesprefertousetouchalonewhenidentifyingobjects.Weshowedhimasimplelathe(atoolhehadwishedhecoulduse)andhewasveryexcited.WeshowedithiminaglasscaseattheScienceMuseuminLondon,thenweopenedthecasesothathecouldtouchit.Withthecaseclosed,hewasquiteunabletosayanythingaboutit,exceptthatthenearestpartmightbeahandle(whichitwas— thetransversefeedhandle),butwhenhewasallowedtotouchit,heclosedhiseyesandplacedhishandsonit,whenheimmediatelysaidwithassurancethatitwasahandle.Heranhishandseagerlyovertherestofthelathe,withhiseyestightshutforaminuteorso;thenhestoodbackalittle,andopeninghiseyesandstaringatit,hesaid:'NowthatI'vefeltitIcansee'
Gregory,RichardL..EyeandBrain:ThePsychologyofSeeing,PrincetonUniversityPress,1998
CVIWordCloud
WordstakenfromDisordersofthebrainandhowtheycanaffectvision.InA.H.Lueck&G.N.Dutton(Eds.),Visionandthebrain:Understandingcerebralvisualimpairmentinchildren(p.78-79).
TheoryofMindWordCloud
WordstakenfromSaxe,R.(2007).Theoryofmind.In TheOxfordHandbookofCognitiveNeuroscience.
KeyQuestionstoask• Howisperception(selfandofothers)tiedtocognitionforchildrenwhohaveCVI((inallofitsvaryingexpressions))
• CanTheoryofMind(ToM)tellusanythingaboutCVI?
• CanCVItellisanythingaboutToM?
• AreMirrorNeuronsimportantinthisstory?
TheoryofMind(Recap)
Whatis‘TheoryofMind’(ToM)?
• Term introduced by Premack and Woodruff (1978) • The ability to attribute mental states (thoughts,
beliefs, desires) to others, and to use this to predict and explain their behaviour.
• An innate cognitive module which gradually develops in childhood in typically developing children.
• Known as a ʻtheoryʼ because it involves a system of inferences about states that are not observable.
ToM canhelpusto…
Relatetoothers Empathise
Understandothers’intentions
Mislead ManipulateDeceiveExcludeothers
Predictlikelybehaviour
Correctothers’misunderstandings
Importanttothelifeofchildrenandotherswhohave
CVI
Perceptionsofothers’statesofminds:knowingwhatotherpeoplearethinking
• Akeysocialskillorability
• Multipleexamplesineverydaylife
• Necessaryforeffectivesocialfunctioning,otherwise:
• Mindblindness
• Relativelynewconcept:ToM describedinthe1970s/80s
• Morerecently,providesbridgebetweenchilddevelopment,educationand(social,cognitiveanddevelopmental)psychology
Whatis‘socialcognition’?The cognitive capacities that underlie the ability to interact socially – to understand and reason about other people, in terms of factors such as how people think, feel and react (see Hala, 1997; Tager-Flusberg & Sullivan, 2000).
Metarepresentational ability“The ability to represent the knowledge states (mental representations) of the self and others.”
(Goswami, 2008: 221).
HowCVImayaffectSocialCognition
• perceivethedirectionofsounds• seemovingobjects• understandthecompositionofcrowdedenvironments• takeinthefullenvironmentifthereisvisualneglect• watchsomethingbeingmovedifthereareissuessuchasapraxiaofgaze,smoothpursuitdifficulties
• holisticvsfocalprocessing• faceblindness• Inabilitytointerpretthelanguageconveyedbyfacialexpression• orientationinspace(i.e.,gettinglostinspacewhencannotperceiveandorganizelandmarks)
DevelopmentofToM intypicallydevelopingchildren
• Beginstodeveloparound3yearsofage
• Firmlyinplaceformostby4/5yearsofage.o Tager-Flushberg &Sullivan(2000)
• So…mostchildrenbyprimary1willhaveToM ability.
• But…somelaterthanothers
• Someearlierthanotherstoo…
FactorsthatinfluencehowearlyweachieveToM?
DifferencesinNeglected/LAC?
• Pears&Fisher(2005)studiedToM inchildreninfostercare(aged3-5yearsold)
• ChildreninfostercareweresignificantlylessabletopassToMtasksevenwhentakingaccountofageandintelligence.Deprivationappearstoplayarole.
• ArgueacaseforinterventionstotargetthesechildrentohelpToM andemotionunderstanding(whichtheyalsofoundimpaired)
• CVIandSocialDeprivation(Ravenscroft)
FactorsthatinfluencehowearlyweachieveToM?
CulturaldifferencesinToM?
• Consensusisno…ToM isuniversal
EG• Sabbagh etal.(2006)• StudiedEFandToM inAmericanandChinesepreschoolchildren.• ChinesechildrenbetteronEFtasksbutnotbetteronToM tasks.
FactorsthatinfluencehowearlyweachieveToM?
Siblings• Siblingeffectswelldocumented
o Zajonc (1983)NumberofsiblingscorrelateswithIQ
• Perner etal.(1994):ChildrenwithsiblingshavebetterToM• Ruffman etal.(1998):olderbutnotyoungersiblings?Why?...Lewisetal.(1996)– apprenticeship?
• Dunnetal.(1991)Mothers’narrativeisalsoimportanto Apprenticetomaternalsocialinteractionaswellassiblings?o Roleoflanguage(RoleofLanguageinCVI– speedofinput/processing/)
• Child’sowncharacteristicsimportanttoo
AttentionvPerceptionToM VCVI
• Sustainedattentionistheabilitytofocusononespecifictaskforacontinuousamountoftimewithoutbeingdistracted.
• Selectiveattentionistheabilitytoselectfrommanyfactorsorstimuliandtofocusononlytheonethatyouwantwhilefilteringoutotherdistractions.
• Alternatingattentionistheabilitytoswitchyourfocusbackandforthbetweentasksthatrequiredifferentcognitivedemands.
• Dividedattentionistheabilitytoprocesstwoormoreresponsesorreacttotwoormoredifferentdemandssimultaneously.Dividedattentionisoftenreferredtoasmulti-tasking.
• Attentionisacentralprocessandperceptionisnotpossiblewithoutattentionalprocesses.
• Thatmeansattentionprecedesperception.
• Attentionalprocessesservevariousfunctionsintheorganizationofourperceptionsandothercognitivefunctions.
• IfyoucannotattendthenthishassignificantimplicationsforToM
FactorsthatinfluencehowearlyweachieveToM?
PrecursorstoToM development?• Earlier/otherabilities?
• Cognitiveabilities?oCognitiveabilitiessuchasmemory,attention,inhibitionlinkedwithhowquicklyweachieveToM (Devine&Hughes,2014).SoundsabitlikeCVI
oParticularfocusonimportantroleofexecutive(frontallobe)functions– mediationofattention?SoundsabitlikeCVI
o EF>ToM>SocialBehaviour:whichEFsareimportant?
Assessing(ortestingfor)ToM• FalseBeliefTasks• ValueBeliefTasks• Desire-emotiontasks• NotownDesireemotiontasks• Ignorancetasks
WellmanandLiu(2004)ScalingofTheory-of-MindTasks.ChildDevelopment,Vol.75,No.2(Mar.-Apr.,2004),pp.523-541
FalseBeliefCommonly-usedassessmentofToM
• UnexpectedtransfertestoVariousversionsofthiskindoftask
oOriginalversion:SallyAnnTaskcf Maxi
• Deceptiveboxtask(unexpectedcontents)
SallyAnnTask• Ballplacedintobasketwhenboth
SallyandAnnpresent.
• AnnmovesballwhenSallyisoutoftheroom.
• DoesSallyknowwheretheballiswhenshereturns?
• PassResponse:No,Sallydoesnotknowandcheckswheresheleftit.
• FailResponse:Yes,Sallywillknowwheretheballisandwillcheckinnewlocation
SallyAnnTask
• DevelopedbyBaron-Cohen,Leslie&Frith(1985)o Prof. DameUta Frith>Prof. SimonBaron-Cohen
• OriginalstudyaimedtocomparesocialunderstandingofchildrenwithAutism,Down’sSyndrometohealthycontrolchildren.
Findings:• 85%oftypicalchildrenpassedToM task• 86%ofchildrenwithdown’ssyndromepassed• Around80%ofchildrenwithocularimpairmentpassed• Only20%ofchildrenwithautismpassed
DonotknowrechildrenwithCVI
BUT……………….
• Lowacuity,• Contrastsensitivity• Visualfielddeficits• Simultanagnosia• Prosopagnosia• Integrativeagnosia
Canallprecludeaccesstothevisualelementsofthescenerequiredtobothlearnandexhibittheoryofmindthroughthistypeoftesting.
Issueswiththetask
• Gopnik (1993);Gopnik &Astington (1988)
• Needmetacognitionfirst(thinkingaboutthinking)…needtothinkaboutwhatyouthinkfirst…necessarybeforethinkingaboutwhatsomeoneelsethinks. (thinkaboutdevelopingmetacognitionasapriorityinchildrenwithCVI??)
• AlisonGopnik:testsshouldbemoresimple
MetacognitionissueswithVIandCVI
• itmaybehardertoreadandgivesocialsignals• personalstylemaybelessempathic;• playwillbelesslikelytoincludepretence (thisisbecauseimaginative• playmaybedependentonunderstandingmentalstates);• learningmaybeproblematicatschool,partlybecauseoftheliteralinterpretationoflanguage,andbecauseofdifficultiesinadjustinglearntbehaviour tothecontext
(Pring,L.(2008) PsychologicalcharacteristicsofchildrenwithvisualimpairmentsLearning: memoryandimagery.BritishJournalofVisualImpairmentMay2008)
TheoryofMindandVisualImpairment(Ocular)
IthasbeenarguedinthepastthatvisionplayedacriticalroleinToM
AssuchChildrenwithVIweredelayedinacquiringToM
Minteretal(1998);Sonksen andDale,(2002);Korkmaz (2001)Greenetal(2004);Brambring andAsbrock (2010)
Explanation:individualshadlittleexperienceinsocialintegrationsandthereforenotlearntaboutothersmentalstates– couldn’tseesocialinteractionsandnotjudgegapbetweenexperienceandverbalinteraction(Dyck etal2004.
However, TheoryofMindandVisualImpairment(Ocular Studies)• RecentStudies• Beeger etal2014,• Pijnacker etal2012,• Variousneuroimagingstudiessuggestthatbilateraltemporoparietal junction,medialprefrontalcortex,precuneus andanteriortemporalsulci suggestthatblindnessdoesnoteffectToM northedevelopmentofit.
• Sak Wernica (2015)NodifferenceswerefoundwithVIandSightedintheirfirst-orderandhigher-orderToM use.
• Butthestudyshowsthatpeoplewhoareblindmayunderstandotherpeople’sintentions,feelingsandbeliefs differentlythanpeoplewhoaresighted
“Combinedbehavioural,anatomicalandfunctionalbrainstudiesinsightedandincongenitallyblindindividualsareprovidingnovelinsightsontheeffectsof(lackof)visualexperienceonthedevelopmentandfunctioningofthehumanbrain.Agreatdealofthebraincorticalfunctionalarchitectureappearstobeprogrammedtooccurevenintheabsenceofanyvisualexperienceandabletoprocessnon-visualsensoryinformation,apropertythatcanbedefinedas supramodality”
• Ricciardi etal(2014)Mindtheblindbraintounderstandthesightedone!Isthereasupramodal corticalfunctionalarchitecture?Neuroscience&Biobehavioural Reviewes.Vol41,p64-77
OurView(OcularVisualImpairment)
• IsseemsthereisnolinkbetweenadelayedToM andOcularVisualImpairment
• ThinkofDanielKish– hasexcellentToM buthasnoeyes– butarewiredvisualbrain.
• Aredifferencesareduetotypeoftest?
• Dodifferenttesttypeactivatedifferentareasofthebrain?
• PerhapsthesedifferentareasresultsindifferencesbutnotadelayorabsenceofToM.
• PerhapsVisionsupramodality isresponsibleforpositiveresults?Whoknows?
ToM andCerebralVisualImpairment
• Verylimitedliterature
• Clearlyadifficultandneglectedfield
• Butlet’sexploreCVIinabitmoredetail
VisionInvolvesMoreThanTheEyes,and…..
VisionisProcessedinManyPartsoftheBrain
FROMSECRETLIFEOFTHEBRAIN:PBS
ButfirstaquickRecap
Analysingthevisualsceneandgivingattention
• Cooperationofthreeareasofbrain
1 Posteriorparietallobes:appraiseoverallvisualscene2 Temporallobes:recognise3 Frontallobes:mediatechoice
VisualFeaturesofCVI
Area of Damage Seen on MRI Scan Visual Features to Look For
Occipital LobesLeft occipital lobe ● Lack of visual field on the right side for
both eyesRight occipital lobe ● Lack of visual field on the left side for
both eyesBoth occipital lobes ● Impaired central visual functions of
acuity, contrast, and color● Lack of visual field on both sides (often
manifesting as visual field constriction)● Severe damage causes profound visual
impairment
ReprintedfromDutton,G.N.(2015).Disordersofthebrainandhowtheycanaffectvision.InA.H.Lueck&G.N.Dutton(Eds.),Visionandthebrain:Understandingcerebralvisualimpairmentinchildren(p.78-79).NewYork:AFBPress.
PosteriorParietalLobesLeft posterior parietal lobe
ü Intermittent lack of attention on the right sideü A tendency to miss people and events on the right sideü A tendency to bump into people and objects on the right side, especially when
upset or tiredü Reduced accuracy of visual guidance of movement of the right side of the bodyü A tendency to be left-handed (because this becomes the dominant hand)ü Weakness of the right side of the body (as a result of damage further forward in
the brain)ü Difficulties with spoken or written language (because the left parietal lobe
serves language)ü When drawing, the right side of the picture can be distorted
Right posterior parietal lobe● Significant lack of attention on the left side and intermittent lack of attention on the
right side (Ting et al., 2011)● People and events on the left side are frequently missed● People and objects on the left side are frequently bumped in to● A tendency to be right-handed● Weakness of the left side of the body
PosteriorParietalLobes(Both)
Both posterior parietallobes
(Severe damage affecting the
cortex, white matter, orboth)
● Inability to see more than one or two items in a visual scene at once (simultanagnosia), despite the requisite visual field.
● Inability to use vision to guide movement, accurately despite sometimes having clear three-dimensional vision
● Inability to give attention to more than one or two things atonce.
● Noise or conversation can make the child lose visualattention.
● Inability to move the eyes from one target to another at will, despite ability to move the eyes.
● Profound lack of ability to see moving targets is common.● Lack of lower visual field below the horizontal midline.
TemporalLobes
Left temporal lobe ● Impaired object recognition (objectagnosia); color recognition may beused to compensate.
● Impaired shape recognition (shapeagnosia).
● Difficulty learning the shapes of letters (alexia).
Right temporal lobe ● Impaired face recognition (prosopagnosia).● Impaired ability to see meaning in facial
expressions.● Difficulty being orientated (may be
profound) and navigating known environments (topographic agnosia).
BothTemporalLobes
Bothtemporal lobes ● Combinationoftheimpairedabilitiesdescribedfortheleftandrighttemporallobes(integrative agnosia).
● Difficultyknowingthelengthandorientationoflines,orsizeof objects.
● Impairedvisualmemory(oftenwithrelianceonauditorymemoryandlanguageability).
AsDutton,Chokron,LittleandMcDowell(2017)say
“Theposteriorparietallobesthusreconfigurevisualinformationreceivedviathedorsalstreamfromtheoccipitallobesandfromthemiddletemporallobesthatprocessmovingimagery.Theycreatethenonconscious virtual,dynamicthree-dimensionalpictorialandauditory, mentalemulationofthestructureofoursurroundingsthatenablesustomoveaccuratelywithoutcollisionandinjury”
WealsoknowfromPre-termChildren……
• Childrenbornextremelypretermareatriskofvisualprocessingproblemsrelatedtobraindamage.
• Damageinvisualpathwayscanremainundetectedbyconventionalmagneticresonanceimaging(MRI)andfunctionalconsequencescannotalwaysbepredicted.
• Delaysinprocessingvisualinformationcanbeidentifiedinchildrenbornextremelypreterm.Thedelaysmightbeascribedtodeficitsinneuronalconnectivityinvisualpathwaysatamicrostructurallevel.
Pel etal(2016)Earlyidentificationofcerebralvisualimpairmentsininfantsbornextremelypreterm.DEVELOPMENTALMEDICINE&CHILDNEUROLOGY,Vol58Issue10,p1030-1035
Dutton’sworktellsus
• Childrenbornpretermareatriskofdisorderedtemporalprocessingofvisualinformation.
• Whetheritistheperceptionandinterpretationofrapidchangesinfacialexpression(contributingtoacquisitionoftheoryofmind);
• theabilitytomatchone'smovementstothemovingvisualscenetonavigateinacrowdortocatchaball;
• ortheabilitytofindandfollowsomeoneinamovinggrouporrecognizetheirmovements – allmaybeimpairedbydeficientvisuotemporalprocessing.
• Rapidsequentialimagecaptureandprocessingisneededtopickupthenuancesofsocialinteraction,whiletemporalimagesummation,whichengagesbothcerebralandcerebellarfunction,isrequiredtodifferentiatetheflowingimagesofarunningorwalkingperson.
AndwealsoknowfromworkinCerebralPalsy
• MoreworkonthisthanonchildrenwithCVI
• Adegboye etal2017.HighersocialandemotionaldifficultieswerefoundinthedystonicCPgroupcomparedtothecontrolgroup.NonverbalparticipantswithdystonicCPwerefoundtopresentwithgreatersocialimpairmentandlowerToM abilitythantheirverbalcounterparts.Emotionalregulationandhyperactivityandattentionaldifficulties(HAD)significantlypredictedToM abilityandsocialdifficulties.LowerGrossMotorFunctionClassificationSystem(GMFCS)levelandIQalsocontributedtodifferencesinToM ability.
• Caillies etal(2012)“ResultsclearlyindicatethatchildrenwithCPencounterproblemswithrecursiveToM [secondorderfalsebelieftasks] andironycomprehension”
• Dahlgrenetal(2010)“CPchildrenperformedworsethanmatchednonCPcontrols”
• Falkman etal(2005) ”therearechildrenwithcerebralpalsywhofailtosolvetheoryofmindtasksirrespectivelyoftheverballoadingofthetasks”
• Lietal(2014)“Impairedtheoryofmindinthechildrenwithcerebralpalsyisreported”
Thissuggests
• IfChildrenwithCPinadditiontothosewhoarebornpre-term(before28weeksgestation)appeartohavedifficultywithToM development
• ItjusthastobethecasethatChildrenwithCVIhavedifficultywithToM – doesn’tit???
• (eventhoughthereisno[asyet]concreteresearchevidenceforthis)
Solutions
• SowhatdoesthismeanforPractitioners
MaybehelpcanbefoundthroughMirrorNeurons(Galleseetal.,1996;Rizzolattietal.,1996;RizzolattiandFadiga,1998;RizzolattiandCraighero,2004).
https://garfield.com/comic
ReallyInterestingStudy
• Ricciardi etal2009.DoWeReallyNeedVision?HowBlindPeople“See”theActionsofOthers.JournalofNeuroscience 2009, 29 (31) 9719-9724;
• CongenitallyBlindParticipantsN=8Meanage44Norecollectionofanyvisualexperience+congenitalglaucoma(n =5),retinopathyofprematurity(n =1),andcongenitalopticnerveatrophy(n =2).
• 14SightedParticipants
• FMRI
• Presented20actionand10environmentalsounds• MotorPantomimetask(participantstobevirtuallyhandedobjects/tools)
• PresentedalsowithMoviesandSound
• themirrorsystemcandevelopintheabsenceofsightandcanprocessinformationaboutactionsthatisnotvisual.
• congenitallyblindindividualsshowedactivationinapremotor–temporoparietal corticalnetworkinresponsetoaurallypresentedactions,andthisnetworkoverlappedwiththemirrorsystembrainareasfoundinsightedsubjects.
• Studieshavealsorevealedthatindividualswithnovisualexperiencerelyonsupramodal brainareaswithintheventralanddorsalextrastriatecortex,
Andsoifallofthisis“true”/“Correct”?????
• Ifmirrorneuronsareactivatedbyauditory(andthereissomeargumentfortactile)informationthenweagreewithvanDijk andothersthatusingtheMirrorNeuronSysteminalearningprogramfor(young)childrenwithdevelopmentaldelayorsensoryimpairment(s)opensnewperspectivesforsuccessfulhabilitationanddevelopmentofatheoryofmind.
Whatdoesthismeantothepractitioner
(1) prolongfacialexpressionswhilefacingthechild,(Mirroringtheface)(2) complementingemotionsthroughsimplesalientlanguage;(activationofmirroring)(3) speakclearlyaboutthechild'sexperiences,,prolongingexplosiveconsonants
(activiation ofmirroring)(2)chooseslow-movingunclutterededucationalmaterial;(activationofmirroring)(3)minimizevisualclutter,(whatareyoumirroring)(5)identifyandcaterforanyassociatedperipherallowervisualfieldimpairment;(cannotmirrorwhatyoucannotsee)(6)keepbackgroundnoisetoaminimum,especiallywhentalking;(Whatisbeingmirrored)
Dutton,2016,LueckandDutton2016etc………….
BacktoRepresentation
• WellIdonotknow“Whatitisliketobeabat”(Nagal,1974)
• Butwearebeginningtounderstandwhatform,functionandkindofmentalrepresentationchildrenwithcerebralvisualimpairmenthave
• Andtheevidenceleadsustosuggestthatthereisadeficitofatheoryofmindbutthatdeficitcanperhapsbereducedandevenoverturned.
• Butmoreresearchonthisisdefinitelyneeded.
Thanks
• Thankyouforindulgingmyramblings
• Ifyouwouldliketocommentorenhancethistalkinanywayletmeknow
• BTWReferencesareavailableIjusthaven’taddedthemtothepowerpoint yet.Sorry.