Children as intentional agents: The contribution of sensitive caregiving on the way to the development of theory of mind
Sezin Önerup1
1 Dogus University - soner@dogus.edu.tr
Abstract
This paper presents a review of the processes involved in the development of the theory of mind in children through an intersubjective approach. More specifically, the development of the theory of mind was examined in the context of the child-caregiver attachment. For this purpose, studies examining the links between various theory of mind variables (e.g.: joint attention, symbolic play, language skills) and parent-child interaction variables (e.g.: maternal sensitivity, reflective functioning) were reviewed. In summary, variables pertaining to the parent-child relationship, reflective functioning and maternal sensitivity in particular, are argued to be the key determinants of a child’s affect regulation and self organization.
Introduction
One major aspect of human social understanding is the theory of mind which explains how an individual responds not only to others’ actions, but also to aspects of the others’ mental states such as beliefs, desires, intentions, feelings and attitudes (Baron-Cohen, 1995). During the last two decades, the concept has been the focus of cognitive and developmental psychology (Wellman, 1993; Baron-Cohen, Tager-Flusberg & Cohen, 2000; Perner, 1991). Researchers in this area hold different views in regard to the origins or development of theory of mind. However, the currently dominant view holds that there exists an innate capacity for theory of mind; and that children, even when they are very young, are able to attribute their internal states as causes of their actions (Baron-Cohen, 1995; Leslie, 1994). In this article, after providing a brief review of prominent approaches concerning theory of mind, the characteristics of parent-child interaction linked to the child’s mentalization capacity will be explored relying upon previous theories which focus on social development in understanding theory of mind (Fonagy & Target, 1997; Goldman, 1993; Gopnik 1993; Wellman, 1990). Discussions on theory of mind are somewhat limited due to the fact that researchers have concentrated more on beliefs and desires, and have rather neglected the influence of emotions. This might be because belief-desire reasoning seems to be more connected to causal understanding and also to making predictions. However, as Fonagy, Gergely, Jurist and Target (2004) argued, emotions might also stand for intentional stances as beliefs and desires and have common representational characteristics. They also distinguished feeling states from beliefs and desires in the sense that emotions are processed with accompanying changes in physiological arousal and corresponding subjective appraisals. Moreover, emotions are easier to detect and, in the case of some basic emotions, are argued to be innate (Ekman, 1992). Considering these interpretations, Fonagy and colleagues defended the intersubjectivist view of theory of mind and proposed the term reflective function referring to theory of mind (Fonagy & Target, 1997). More will be examined regarding this concept later in this article; however I find it important to briefly mention other ideas on theory of mind to assure a basic understanding of the different explanations of the concept.
Theories on Theory of Mind
There is an ongoing debate on the development of children’s acquisition of theory of
mind, and on the operationalization of the concept for research purposes (see
Baron-Cohen et al., 2000, for a detailed review). The modular approach – as
explained by Leslie (1994) and Baron-Cohen (1995) - asserts that there is an innate
learning mechanism specifically devoted to social understanding. These authors
stressed the evolutionary and biological origins of theory of mind and paid little
attention to social influences. Briefly, modular theorists argue that at around three
years of age, children achieve a level of cognitive sophistication that allows them
to understand the intentions behind the actions of others. The modular approach views
theory of mind as an ability that is inherent and then later activated.
Other theories focus more or less on aspects of social learning. One of them, the
theory-theory approach (Gopnik, 1996) assumes that children develop theory-like
interconnected mental concepts based on their experience in life. Theories that are
built automatically and innately are, however, also ‘tested’ in social
interactions. In that sense, this approach claims that the developed theories are
innate although, as mentioned, the child’s social environment serves to instantiate
these mental theories. Perner (1991, p. 11) refers to this process as the “dramatic
realization of mind” and explains that “the individual switches from the mentalistic
theory of behavior to representational theory of mind.”
The other
social learning approach, simulation theory (Harris, 1992; Goldman, 1993) suggests
that children simulate or imagine themselves to be the other person, and consider how
they would feel, think and act in that person’s circumstances. Simulation theorists
hypothesize that mental representations arise from introspection, or in other words,
mind reading. However, this theory does not account for how children come to think of
their own selves, which is an important point that this theory falls short of.
From the perspective of developmental psychopathology, none of these theories
explain the full picture, because they have not considered the child’s own capacity
to construct a mental ‘theory’ but rather emphasize only what the biology or the
environment provides him with - no less and no more. On top of that, the child’s
affective interactions, specifically with the primary caregiver, play a major role in
determining their later functioning (Slade, 2009; Fonagy & Target, 1997; Meins,
Fernyhough, Russell, & Clark-Carter, 1998), and a more comprehensive account should
explain the mother’s contributions to the development of the child’s theory of
mind.
In this regard, considering the impact of early relationships, Fonagy
and Target (1997) proposed the term reflective function to explain children’s
“ability to respond not only to others’ behavior but also their conceptions of
their own beliefs, feelings, beliefs, pretense, plans and so on” (p. 679). The term
reflective function refers to the cognitive and affective processes that are
hypothesized to be the precursors of theory of mind. According to this view, the
caregiver is a means for the child to discover the world and incorporate the new
information into the child’s mental system. Also, the nature and the quality of
this learning and development process are very much influenced by the dynamics of the
dyadic interaction. Thus, interactions with the primary caregiver provide a strong
base for the child’s developing representational mind from which the child’s
social cognitive abilities evolve and assist the child to think and understand the
self and the other in terms of mental states (Slade, 2009).
Caregiver Sensitivity and Secure Attachment in the Development of Mentalization
Early attachment theorists defined caregiver sensitivity as the caregiver’s ability
to be aware of the child’s signals and to evaluate and respond to them in a
meaningful, accurate, and appropriate way (Ainsworth, Bell & Stayton, 1974). However,
it is rather difficult to objectively measure sensitivity; for this reason it is
somewhat of a generic concept and different frames of reference have led to different
conceptualizations of sensitivity (Belsky, Rosenberger & Crnic, 1995). As Meins
(1997) argued, the term sensitivity covers a range of behaviors, and it is difficult
to interpret which ones are more integral to the concept. On the other hand, the
relationship between caregiver sensitivity and attachment patterns is clearer.
Previous research consistently found maternal sensitivity to be associated with the
development of a secure bond between the child and the caregiver (Andrea & Kirkland,
1996; De Wolff & van Ijzendoorn, 1997; Bakersman-Krannenberg, van Ijzendoorn, 1995).
With respect to this, Fonagy and Target (1997) proposed the concept reflective
function as being almost analogous to caregiver sensitivity in terms of predicting
attachment security. They utilized Dennett’s concept of intentional stance,
(Dennett, 1987) which refers to the abstract level of the mental system that is an
evolutionary adaptation through which individuals make causal attributions about
others’ actions and internal states. Dennett (1987) argued that at the level of
intentional stance, individuals are able to make inferences about others’ mental
states that may not reflect the actual reality. The terms, intentional stance
(Dennett, 1987) and reflective function (Fonagy & Target, 1997) refer to functionally
similar concepts especially with their emphasis on social experience. However, these
two views explain the developmental processes of social understanding in somewhat
different ways. Dennett considers intentional stance to have evolutionary origins,
whereas reflective function refers to the quality of early interactions. I favor the
latter one on which more will be explored in this article.
In order for
children to develop abstract conceptions of external reality, first of all, they need
corresponding mental representations. In this regard, Fonagy and colleagues (2004)
explained the development of theory of mind, or as they refer to it, reflective
function, in relation to early interactions with the caregiver. They argued that as
children initially form mental state representations, their mother reflects their
internal states back in dyadic interactions. Therefore children are exposed to two
very similar notions of the experience, one is that of their own and the other is the
mother’s conception of that experience. The two are actually the same experience
but are different in ‘theorizing’. Gradually, with the mother’s appropriate
mirroring, the children gain awareness of their own internal states and also of internal
states of others, which is an important step in their acquisition of theory of mind.
The caregiver’s capacity to monitor and reflect the child’s
moment-to-moment states has been associated with maternal sensitivity in the sense
that maternal reflective function is a strong predictor of both secure attachment and
adaptive, coherent mental organization (Fonagy, Steele, Steele, Higgitt, & Target,
1994; Fonagy, Steele, Moran, Steele, & Higgitt, 1991; Gergely, Nadasdy, Csibra, &
Biro, 1995). Maternal reflective capacity might be considered much the same as
Bion’s (1962) conceptualization of the mother as a container. According to Bion’s
model (1962), sensitive mothers contain or keep the child’s negative affect, and
then respond back in an affectionate, accepting manner. Thus the child becomes able
to tolerate negative emotional states and is supported in this way in the exploration
of the external world.
It could be argued that sensitivity predicts later
mentalization capacity only if we are referring to the caregiver’s capacity, or
efforts to interact with the child’s mental states and reflect such internal
experiences in an accurate and regulative way (for a comprehensive review, see Social
Biofeedback Theory, Gergely & Watson,1996; Zeanah, Benoit, Hirshberg, Barton, &
Regan, 1994). And in that sense, caregiver sensitivity has a major role in the
development of mentalization (Sroufe, 1990; Gergely, 2001) and also in facilitating the
child’s adaptive development (Carpendale, & Lewis, 2006).
The Caregiver’s Role in the Child’s Transition from Physical to Intentional Agents
It used to be the commonly held belief that children are born as passive organisms
with no apparent capabilities. However, during the last three decades, evidence has
shown that children have built-in perceptual and representational capacities that
promote adaptation to their biological and social environment (Stern, 1985). Such
innate mechanisms serve not only to assist the children’s physical survival, but
also to enhance their affective development. Especially children’s emotional
sensitivity and ability to match their actions with the corresponding changes
facilitate the formation of affective communication with the caregiver.
In the first few weeks following birth, children develop an awareness of their physical
self. Their ability to detect changes in the bodies they are in contact with, and to
match these changes with their ongoing responses provides an understanding of their
self as a physical being (Leslie, 1994). It is very important that such a process
provides an initial ground for future emotional development. Affective communication
with the primary caregiver, (usually the mother), begins to develop from the
beginning of life and is essential for the regulation of children’s emotions
(Fonagy et al., 2004; Slade, 2009). As the mother gains more experience with the
child’s responses, she becomes more familiar with, and therefore better in modulating
the child’s emotional states. The mother’s attention to the child’s different
physical responses in different situations contributes to contextualizing
stimulus-response interactions and gradually leads to a more consistent and reliable
caregiving. On the other side, over time, children come to understand that their
physical self is able to initiate causal influences in their environment (Neisser,
1988; Gergely & Watson, 1996; Sroufe, 1990). Therefore, it is clear that mothers play
an active role in children’s discovery of themselves as physical agents. Sensitive
monitoring of physical needs and then responding back to these signals immediately
communicates the mother’s caring and availability, which is essential for the
child’s development of healthy emotion regulatory abilities (Stern, 1985; Sroufe,
1990).
Early emotion regulation is achieved with the mother’s assistance.
Parental affect-mirroring is crucial such that this communication provides the child
a framework to rely on, especially in novel and distressing situations. As the mother
carefully reads the child’s displays of emotion and reflects them back to the child
in a warm, affective and communicative way; these experiences become more meaningful
and more tolerable. Moreover, affect mirroring by means of specific vocal and facial
expressions captures the child’s attention and encourages further reciprocal
engagement. In that sense, appropriate parental reflection is an important feature
for not only the development of a secure attachment system (Zeanah et al., 1994) but
also the development of the child’s coherent self organization (Fonagy & Target,
1997; Gergely & Csibra, 1998).
Affective communication in the early phase
of development involves nonverbal behaviors. Sensitive caregiving, in that sense, can
be characterized as the matching behaviors of smiling, vocal expressions with
face-to-face interactions and direct eye contact (Beebe, Lachmann, & Jaffe, 1997;
Tronick, 1989). Certainly, the timing of reflection is important such that temporal
proximity of one response to the other makes it easier for the child to associate the
two. In other words, temporal contingency in the mother’s affect mirroring
represents consistency and organization for the child. Initially, the mother is more
likely to be the coordinator and the child to be the receiver of the dyadic
interaction. As the child gradually becomes more sensitive to contingent
communication, the interaction becomes more automatized such that the child both
expects to be mirrored and begins to respond to maternal reflections.
As
the name mirroring implies, correspondence of two responses in content facilitates the
synchrony in interaction, and also provides comfort for the child to experience the
actual state (Malastesta, Culver, Tesman, & Shepard, 1989). As the mother becomes
more able to differentiate and model the child’s affective signals, the child feels
more secure to express emotions expression, which then fosters the development of
self-understanding (Stern, 1985). In that sense, synchrony in dyadic interaction is
essential for an adaptive psychological development. Previous research found that
communication between depressed mothers and their children consistently involves
negative emotions; therefore these children are more likely to experience emotion
exchanges that are less contingent to their state (Fonagy et al., 1991). Mismatch of
internal state and information from the environment, like this, leads to disturbances
in children’s cognitive and affective development (Murray, 1992; Fonagy & Target,
1997).
Gergely and Watson (1996) proposed the social biofeedback theory of
emotion regulation that also contributes to our understanding of the development of
mentalization. According to the model, children, back and forth, test the
caregiver’s emotional responses to catch the consistently occurring responses.
Contingency testing serves children’s need for stability and security to the extent
that they maximize their ability to interpret both their own, and others’ affective
states. In this process, the caregiver’s role is to read and interpret the
child’s internal states accurately. As the child’s vocal or postural emotion
expressions find consistent matching responses, internal experiences come to be
represented externally and are observable. Therefore, sensitive caregiving in this
non-mentalistic developmental phase precipitates the child’s self-understanding and
later the child’s meaning-making system. (Gergely & Watson, 1996; Gergely, 2001,
Fonagy et al., 2004).
Sharp, Fonagy and Goodyer (2006) pointed out the
impact of maternal reflection in determining the child’s perception of actual
experiences with respect to the internalization process. Whether it represents the
actual experience or not, children perceive the mother’s reflective affect displays
as their primary emotional state. Incongruence between the actual experience and the
reflected affect distorts the child’s self-understanding and leads to the
development of a false self (Winnicott, 1967). Besides categorical congruence,
sensitive mothering ensures marked affect mirroring that is characterized as reflective
behaviors that are the exaggerated versions of the child’s realistic affect expression
(Fonagy, Target, & Gergely, 2000). As the mother reflects emotional states in a
contingent but imperfectly matching way, children gradually become able to
differentiate the mother’s emotional state from theirs, which is an important
developmental process in terms of the formation of secondary mental state
representations (Fonagy et al., 2004; Sharp, Fonagy, & Goodyer, 2006). Fonagy and
Target (1997) explained appropriate affect mirroring in a similar way. They argued
that in response to the child’s experiences of negative affect, the sensitive
mother produces reflective behaviors involving mixed emotions with vocal, facial, and
gestural displays of the experienced affect. This not only makes the situation more
tolerable, but also facilitates the child’s emotion regulation abilities (Fonagy,
1995). Therefore, appropriate parental reflections require both categorical
congruence and perceptual markedness for psychological well-being and coherence in
mental organization. Infants whose mothers do not use marked expressions in their
reflections tend to develop disturbed self perceptions and self regulation, and this
in turn makes them vulnerable for borderline psychopathology (Fonagy, 1995; Fonagy,
Target, & Gergely, 2000).
So far, I have briefly reviewed basic
characteristics of sensitive caregiving especially in terms of affect regulation. How
then, does maternal sensitivity impact later development of theory of mind? The
process is as follows. The mother’s highly contingent but imperfect affect
mirroring serves the child’s development of a sense of understanding of their
experiences and fosters the feeling of efficacy to regulate their environment. Such
an interaction in the early dyadic relationship provides children the secure base
from which they explore the world (Sroufe, Carlson, Levy, & Egeland, 1999). With the
sense of security and agency, children are inclined to engage in diverse experiences
in their physical environment. Moreover, children feel more comfortable to interact
with people other than the mother, which is important for the generalization of early
experiences (Dunn, 1996). Therefore we can state that, firstly, secure attachment and
early sensitive care provide the appropriate psychosocial environment in which
children develop a basis for mentalization. (Meins, 1997 ; Meins, Fernyhough, Russell, &
Clark-Carter, 1998 ; Fonagy & Target, 2002). Secondly, sensitive mothering, with marked
affect mirroring qualities facilitates the formation of second order mental
representations. As children perceive the mother’s reflections as being a different
expression of their actual affective state, they form a separate mental
representation of this state. This secondary representation is an abstract form of
the primary affect and is still linked to actual experience. As Gergely and Watson
(1996) emphasized, this process makes subjective mental states cognitively more
accessible, which then fosters children’s sensitivity to internal states in general
(Gergely & Csibra, 1998 ; Stern, 1985). However, it is important to note that this
state of mind can be considered as a readiness state for the development of
intentionality and is very important in the sense that it sets up the early framework
for children’s sociocognitive development. (Gergely, 2001).
9-Month cognitive revolution
At around 7-9 months of age, children develop major skills that are considered important
for later metacognitive development. At this stage, they gain an increased awareness of
the physical constraints of the external world and realize that others’ actions are
dependent upon these constraints. Such an understanding helps them to differentiate
rational actions from nonsense ones. Gradually, with increased sensitivity to
relations beyond their own, children acquire the ability to infer goal states from
simple means (Gergely & Watson, 1996; Gergely & Csibra, 1998).
These
developmental changes are also manifested in dyadic interaction. As infants gain
increasing motor abilities, they interact with the external environment more frequently.
However, although children are more interested in exploration from this point on,
they still check for the mother’s availability and try to match their experiences with
the mother’s. The mother’s availability, in this process, is the key to the
child’s feeling of security, but the mother also serves as an important source of
information for the child’s exploration (Ainsworth et al., 1974; Bowlby, 1980). As
the child encounters a novel or especially distressing situation, the mother’s
responses provide reflections about that experience. As Hobson (2002) termed it, a
relatedness triangle is formed in which the child and the mother attend to a third
object. In that relatedness triangle, the child continuously searches for the
mother’s matching responses with those of their own experience. Awareness of the
shared affect with different goal states regarding a third object allows the child to
the understand that individuals might hold different views about the same reality
(Wellman, 1993).
Infants’ newly emerging skills of joint attention, gaze
following, protodeclarative pointing and use of gestures constitute important
landmarks of social-cognitive development. First of all, in order to repair the
mismatch in the communication, the child continuously looks for maternal signals to
organize experiences depending on the mother’s ascribed meanings. In time, the
child improves in detecting and interpreting mental states, both their own and
others’ (Neisser, 1991; Wellman, 1993). Secondly, the mother’s reflective function
and cooperative behaviors provide the child a sense of security that fosters further
exploration, and also provides support accordingly. This pattern of interaction,
which can also be termed secure attachment, promotes the child’s sense of agency
and self-esteem (Carpenter, Nagell, & Tomasello 1998 ; Stern, 1985). Therefore, it
can be argued that these newly developed skills can be utilized to support maternal
reflection and pave the way for more sophisticated cognitive development.
Maternal responses in joint attention are critical for the child’s internalization
process. As I mentioned above, optimal affect mirroring is characterized by sensitive
monitoring of the child’s state of mind, and by reflecting it back in a highly
contingent manner but with imperfect expressions (Fonagy & Target, 1997; Fonagy et
al., 2004). In negative situations, the mother attends to the child’s affective
state and reflects it back to the child in a more tolerable way, for example with
accompanying sweet voices. Therefore, maternal sensitivity supports the child in
regulating the negative affect and remain in distressing situations, which in turn
gives the child the sense of power, agency and the necessary courage for new
experiences. In positive situations, the mother’s exaggerated displays of emotion
encourage the child’s engagement in the situation and therefore it is more likely
that the child receives more pleasure from reinforcement (Sroufe, 1996).
Attachment literature has generally associated maternal sensitivity and responsiveness
(Isabella, 1993). As might be expected, a sensitive caregiver is also responsive to the
child’s physical and emotional needs, attends to their mental states and responds
in a consistent, unambiguous way. This kind of interaction strengthens the child’s
causal attributions of ongoing experiences, which is important for the development of
an organized meaning-making system and an integrated sense of self (Meins, 1997). In
that sense, Meins (1997) conceptualized maternal mind-mindedness, referring to the
mother’s ability to think of the child as an intentional agent, which is practically
very similar to the mother’s reflective function (Fonagy & Target, 1997). Meins
(1997) conceptualized maternal sensitivity as a process during which the mother treats
the child as an intentional agent with their own interests, beliefs and desires even
when they actually have not yet developed these mental abilities. These mothers, as
Meins (1997) argued tend to observe the child’s internal states carefully and
scaffold the child towards the goal state. The mother’s cooperation and regulative
responses make it easier for the child to adapt to ever-changing states and to move
forward accordingly. This, in turn, supports the feelings of agency and adequacy. The
mother’s representation of the child as a mental being is naturally communicated in
the mother’s interactions with the child, and so the child gradually develops a
more abstract understanding of the self and the other (Meins, 1997; Meins et al., 2002).
In consideration of the facts stated above, the first year of life is very
critical in shaping the sociocognitive development. Although children’s thinking
and reasoning skills function in non-mentalistic terms, both social and cognitive
skills acquired early in life prepare them for further cognitive sophistication
(Fonagy & Target, 1997 ; Gergely, 2001 ; Wellman, Phillips, & Rodriguez, 2000).
Empirical evidence so far supports the pivotal role of sensitive caregiving in
the development of mentalization capacity. In recent research, Sharp and colleagues
(2006) examined the impact of maternal attribution styles and the nature of
reflective behaviors on the child’s mentalization capacity. They found that the
mother’s inaccurate mirroring and biased attributions lead the child to develop
distorted mental organization. Moreover, it was found that insensitive and coercive
mothering makes them highly vulnerable to conduct disorders (Beauchaine, Gatzke-Kopp,
& Mead, 2007). Most characteristic deficits in social understanding have been
observed in autism, a developmental disorder marked by primarily reciprocal social
communication and theory of mind deficits (Baron-Cohen, 1995). However, early
interventions based on the child’s specific needs can lead to promising
improvements in the child’s social adaptation (Baron-Cohen et al., 2000). For
example, Capps, Sigman and Mundy (1994) reported that securely attached autistic
children, when interacting with their caregivers, engage in more looking, pointing
behaviors, make more eye contact and use gestural communication with reference to a
third object than insecurely attached ones. As Guralnick (1998) pointed out, this
suggests that the mother-child interaction is a major element in early social
environment, and sensitive caregiving in reciprocal-dyadic interaction might help
autistic children to improve and better adapt to the world. Cognitive faculties that
are essential for the development of theory of mind begin to develop very early in
life even without revealing observable deficits. Therefore, preexisting deficits (of
autistic children) can at least be improved to a certain extent through the process
of the parent-child interaction.
Adaptive psychological development, which
can be considered a component of mentalization (Fonagy & Target, 1997), is also
mediated by the quality of early interactions. Mothers of securely attached children
allow their children to freely explore and reflect on their mental states. The
child’s efforts to find meaning in the mother’s mind and to follow corresponding
actions help to differentiate internal states from observable behaviors. This process is
important because the safer children find it to explore the other’s mental state, the
more they will tend to contact with and understand internal experiences. Insensitive
mothering, on the other hand, might result in pathological outcomes in that sense.
Insecurely attached children are more likely to experience disturbed intersubjective
exchanges in dyadic relationships. Specifically, anxiously attached children tend to
focus more on their mental states and are more likely to be overwhelmed by their
negative emotions. On the other hand, children with avoidant attachment are more
likely to escape from the mother’s internal state, which also leads to distancing
from their own states. In general, children with disorganized attachment have rather
more different and complex characteristics such that their experience in dyadic
interaction involves incontingent and inaccurate maternal responses. Those children
develop intentional stances but lack self-organization and coherence (Fonagy &
Target, 2002; Fonagy et al., 2000).
After the emergence of basic
representations of self and others, typically developing children, with cumulating
experience, become able to infer about others’ actions and goal states. Associating
internal states with the observable actions helps children to understand that others
might have prior intentions or desires before they act on these mental states.
Emergence of such related but separate representations of internal states and actions
enables children to infer about mental states even in the absence of observable
actions. Therefore, gradually, children improve in predicting others’ subsequent
behaviors (Gergely & Csibra, 1998). Obviously, the emergence of this naive
representational system is closely connected to interactions with the caregiver in
the early stages of life. In response to the mother’s reflective behaviors,
children begin to organize their experiences, which in time makes it easier for them
to integrate various aspects of experiences into stable schemas. Then the affective
and physical components of collections are formed into basic mental causation and,
generalized and applied to others, as Stern (1985) called it
a-way-of-being-with.
Children whose mothers are abusive or
seriously neglectful have difficulty with establishing mental coherence in their
cognitive organization (Dennett, 1987). These children are more likely to hold
distinct representations of their self - all of which are different from their actual
self. Similarly, these children tend to have contradictory attributions for others which
are in accordance with their perceived self (Fonagy et al., 2000). In that sense,
sensitive caregiving facilitates children’s ability to appropriately respond to
others’ affective states. Distorted causal connections between separate mental
states bias both their understanding and interaction with others (Wellmann, 1993). In
a similar vein, Meins (1997) argued that the mother’s empathic, mind-minded
responses increase children’s prosocial understanding and help them improve in
goal-directed/goal-corrected actions. This means that the child strives to reach a
goal and certainly there are times when the child’s desires are not met. In such cases
of failure, sadness and frustration emerge as the usual effect. However, the child
might also remain engaged and generate other goal-directed actions based on the
interpretations of their previous response (Wellman et al., 2000). Operating on their
own motivational states, with goal-directed and goal-corrected actions, provides
valuable experience for children to understand their own unobservable internal
states. Sensitive mothering ensures ongoing assistance for children to act on
flexibly and organize their environment (Stern, 1985).
At around 2 years of
age, with the development of basic language, the child’s emerging mental structures
are organized into a more complex and strong form (Smith, 1996). The quality of
language that the children have been exposed to influences their understanding of self
and other. Meins (1997) argued that the referential rather than expressive language
acquisition style enhances the child’s abilities to mentalize. As referential
speech revolves around the other object, the child is provided with more explicit,
unambiguous and meaningful information helpful for concept formation. Research
findings (Meins & Fernyhough, 1999; Tomasello, 1992; McElwain, Booth-LaForce,
Lansford, Wu, & Dyer, 2008) provided confirming evidence which additionally points
out the role of maternal sensitivity for the child’s adoption of the referential
acquisition style. Caregivers become reliable sources of information as long as they
carefully attend to the child’s own needs and interests and respond appropriately.
Then, the mother becomes the regular reference for the child to understand the world.
Also, securely attached children are encouraged to engage in argumentative,
referential talk and allowed to make attributions (Meins, 1997; Smith, 1996). It is
also easier for the child to grasp the mother’s communication and the more their
talk is coherent, descriptive and rich in verbal attempts, the better the child gets
at associating novel information into existing structures (Meins & Fernyhough, 1999).
Concerning parent-child interaction, sensitive mothers are more likely to focus
on mutual interests, as in joint attention. As the mother flexibly orients the speech
back and forth to different aspects of ongoing communication, the child is directly
exposed to both the ‘object’ and different attributions in the shared context.
This experience is really important in the sense that the child comes into contact
with different perspectives of the third party. Gradually, the child develops
perspective taking ability and comes to understand context-dependent attributions
(Fonagy et al., 2004; McElwain et al., 2008).
Structural quality of language
also affects the child’s cognitive development. Sensitive mothers tend to use
descriptive, rather than prescriptive language, which provides children flexibility
and coherence in their attributions (Ward & Carlson, 1995). Even in very early
interactions, sensitive mothers tend to interpret their children’s vocalizations and
respond in a clear and descriptive manner. This communication pattern encourages the
child to become involved and this increases the child’s feelings of self-efficacy.
Sense of agency in social interactions, in turn encourages the child’s further
attempts to initiate joint attention and social exchanges with others.
Mothers’ monitoring skills have considerable influence on both language development
and abstract thinking. In the very first place, careful monitoring brings about
appropriate responding. Besides the accuracy of content, the level of understanding
communicated is important. The use of jokes, gestures and affective expressions
conveys greater mental space devoted to interaction (Meins & Fernyhough, 1999).
Fonagy and colleagues (1991) found that the mother’s flexible use of highly
informative mental state terms (i.e. think or know) is associated with the
sophistication of the child’s mentalizing skills. Therefore exposure to abstract
words makes the child more equipped in the development of mentalization capacity
(Fonagy et al., 1991).
Contributions of qualified care: The child becomes a mentalizing agent
The ability to hold mental state representations which was defined as mentalization
capacity (Fonagy & Target, 1997) develops around 4-5 years of age. With this rather
complicated theory of mind system, children gain the ability to integrate the
external and internal reality. Children are, at this time, fully aware that these
representations are not the same but also they are able to symbolize and keep these
representations without dissociating one from the other. Fonagy and Target (1997)
argued that up to this point, children interact with their internal states and the
external reality in two ways: The more primitive form, is the psychic equivalence
mode in which the child expects subjective experiences to match with the physical
reality. The second is the pretend mode in which the child is aware of the mismatch of
the subjective experiences with the physical reality, as in the symbolic play.
Mentalizing ability emerges with the development of more complex cognitive faculties
and the child becomes able to integrate these two modes of relating internal versus
external experiences (Gopnik, 1993).
Mentalization enables children to think
that others’ mental states might also be different from the objective reality.
Therefore, the child’s psychological and physical experiences are arranged into a
meaningful organization system, allowing the child to predict and to have control
over the environment. Moreover, the emerging representational system supports the
child’s individuation process (Fonagy et al., 2004) that requires the child to
mentally separate from the caregiver and develop an independent sense of self. The
caregiver has an active role in this process such that the mother mentally represents
the child’s internal state, and reflects it back to the child (Harris, 1989; Meins
et al., 2002). In other words, the mother provides a mental schema that the child
uses as a template to act on (Fonagy et al., 2004; Sharp et al., 2006).
Beginning from the very early years, children receiving sensitive caregiving are better
at interacting with the mother’s mind (Gopnik, 1993; Slade, 2009). In that sense,
parental affect mirroring is associated with the child’s social understanding. As
long as the mother is able to reflect internal states markedly and accurately, the
child is able to find himself in the mother’s mind (Fonagy & Target, 1997; Fonagy
et al., 2004 ; Slade, 2009). The impact of early caregiving cumulates to that phase
providing the child well-grounded abilities for mentalization.
Play is
another means for children’s development and use of higher order cognitive abilities,
especially at 4-5 years of age. It is easier for mothers to explore their children’s
fantasy world in play settings. In that sense, symbolic play, in which children pretend
to live in a fantasy world, is an important means of expressing internal states.
Similarly, mothers can interact with their children’s imagined world, and help them
to expand and structure their representational world. Sensitive mothers
back-and-forth represent reality versus pretended. Whenever the imagined situation
becomes frightening, the mother scaffolds the child, and supports them in effectively
regulating the negative affect (Slaughter, & Gopnik, 1996). Thus not only the
negative affect becomes more tolerable for the child, but also the child, even in
play, is exposed to effective coping skills for a similar situation (Stern, 1985,
Winnicott, 1967; Fonagy et al., 2004).
Lewis and Boucher (1988) observed
children in symbolic play setting. They found that securely attached children are
better in perspective taking than insecure children such that it is easier for secure
ones to integrate another person’s suggestion into play setting. Lewis and Boucher
(1988) argued that children’s perspective taking ability is associated with their
attendance of others’ mental representations. Also, as Meins and her colleagues (2002)
argued, beginning from the earlier ages of the child, sensitive or mind-minded
mothers tend to use more referential language when interacting with the child. As
might be expected, children of these mothers easily participate in symbolic play and
they tend to be more confident to take the mother’s perspective during the play.
Leslie (1987) proposed that pretend play, in which the mother and child engage
in role taking activities, is an early indicator of the development of theory of
mind. While pretending, the child takes the perspective of a third person (or object)
which requires a rather more sophisticated cognitive development. In order to
accomplish this, the child has to have a basic understanding of the other’s mental
state and also has to isolate mental states from external reality. During pretend
play, the mother continuously monitors the child’s mental state and reflects it to
the child vis-a-vis the third object, which makes pretend play an essential activity
for sociocognitive development. The child’s representational development can also be
inferred in pretend play setting. Children that are stuck in the psychic equivalence
mode, are unable to pretend since their subjective experiences have to match the
external reality (Gopnik & Astington, 1988). As an example, the child can not
role-play a bus driver while actually not being a bus driver. However, if the child
is able to hold separate representations for internal experiences versus external
reality, two states can be disentangled, allowing the child to act as a bus driver
while still remaining a child (Gopnik, 1993).
Inability to move to the
mentalization stage might lead to serious psychopathology in adult years. In cases of
borderline personality disorder, patients could not develop cues for either self or
social understanding, and they lack mentalizing abilities. With internal and external
reality being undifferentiated, they depend in an extreme degree on external reality but
still use cues that are not conditionally appropriate (Fonagy, 2005; Fonagy et al.,
2004). A similar deficit presents itself in a different form in autism. Autistic
children are unable to form representations of internal states. Thus, observable
rules of the external world are perceived to be the absolute reality, which prevents
pretending (Baron-Cohen, 1995).
Interpersonal interactions and mentalization
Children’s interpersonal interactions provide them the means to develop self and
social understanding (Sroufe, 1990; Bowlby, 1980). Meins (1997) argued that social
interactions expose the child to different perspectives in various situations. The
child, then, acquires more and more experiential knowledge that accumulates and is
organized into complex mental structures. Also, causal talks in triadic interactions
support the child’s intentional understanding (Slaughter & Gopnik, 1996).
Previous research found confirming evidence that the quality of social interactions, in
which the mother is the primary figure, affects the development of mentalization. In
their research, Dunn, Brown and Beardsall (1991) reported that children’s
performance on the false-belief task, a measure of theory of mind (Harris, 1989), is
highly associated with the nature of the mother’s interactions with older siblings.
The child observes the mother’s reflective function in other interactions as the
third party, and is exposed to different views in the same situation. This kind of
experience provides the child with an opportunity to interpret these different views and
organize them in a meaningful way. Moreover, the mother’s cooperation as also observed
in other interactions helps the child to generalize and strengthen accumulated
experiences (Astington, 1996). Similarly, Sroufe (1990) found that securely attached
children are better perspective takers and they tend to show greater empathy in
interpersonal relations. Development of skills for empathy and perspective taking is
related to early emerging interactional patterns such as face-to-face interactions
(Tronick & Cohn, 1989), joint attention (Wellman, 1993), symbolic play (Meins et al.,
1998) and conversation styles (Appleton & Reddy, 1996); which are mostly moderated by
maternal involvement. In the course of development, children of sensitive mothers
develop more adaptive social skills which enable them to easily cooperate with peers and
compensate for miscommunication or negative situations (Elicker, Eglund & Sroufe, 1992).
Meins (1997) also pointed out that sensitive mothering fosters the child’s
self-efficacy, which in turn increases the initiation to engage in social exchanges
with others. As the child accumulates different experiences with different people in
different contexts, it becomes easier for them to differentiate the internal states
of their own and others’ from external reality. Mother’s scaffolding, in this
process, provides a secure base from which the child develops agency. Additionally,
the mother supports the child’s exploration process and helps the child to organize
experiences into meaningful representations (Fonagy et al., 1991).
Conclusion and Implications for Adaptive and Pathological Development
Theory of mind, which could also be referred to as reflective function, permits
children to understand not only others’ actions but also their internal states.
Acquisition of this representational ability enables children to organize their
experiences into meaningful constructs, which makes the external world more
predictable for them (Bolton & Hill, 1996).
Recent theorizing on the
development of mentalizing emphasized the inherent capacities, however in this
article I have briefly reviewed empirical and theoretical accounts for the early
emerging capacity within the caregiving context.
Certainly, biological
predispositions affect the developmental processes; nonetheless, as explained above,
the quality of early caregiving has the major role in the development of the child as
a mentalizing agent (Fonagy et al., 2004). Regardless of whether we consider the
development of reflective function from a cognitive perspective (Schachter, 1992) or
from a psychodynamic perspective (Fonagy et al., 1997), it is a mutually agreed point
that early interactional patterns serve as a template for later development. In that
sense, the present article argues that the quality of caregiving - in particular the
degree of maternal sensitivity - contributes greatly to the child’s development of
social understanding.
Although, maternal sensitivity is a problematic
concept to define clearly (Belsky et al., 1995), I agree with previous explanations
(Fonagy et al., 2004) that conceptualize sensitivity in a more global sense. In that
sense, as mentioned above, sensitivity is associated with the mother’s affect
mirroring skills, which leads the child to represent internal states accurately without
being overwhelmed. In the course of development, maternal reflective function, even
indirectly, improves the child both socially and psychologically, which further
facilitates the child’s understanding of self and others.
All in all,
despite the fact that theory of mind has only recently been considered as a module in
its own right, and has only recently begun to be discussed in clinical terms, it is
clearly an important concept that should be studied more not only to understand
different developmental pathways, but also to better understand the broad mental
organization underlying psychopathology. Although there have been studies on
borderline personality disorder (Fonagy et al., 2004) and autism (Baron-Cohen et al.,
2000), future research may uncover representational organization of the minds of
patients with different psychological disorders, that might reveal more to us and
enable us to develop more specific interventions.
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