Producer: Okay, welcome back to Full PreFrontal where we are exposing the mysteries of executive function. I am here with our host Sucheta Kamath.
Good morning, Sucheta, good to be back in the studio with you. So today, you're going to talk about the shroud of mystery and Theory of Mind. What do you mean by that?
Sucheta Kamath: Yes, Todd, good morning to you and this is very exciting that we're going to talk about the theory of mine. So I am going to describe to you an opening episode of 1960s mystery show and the title of this episode was called No Shroud For Shane. This is a story about a private detective Michael Shane who returns from a three-day fishing trip and walks into his office and greets his secretary with a great cheer. The secretary is on the phone and Michael has not processed this but it appears that she is in a state of shock. She's on the phone and she's answered something or heard something on the phone. Clearly, the viewer can tell that she's in a state of shock and when she sees Michael at the door with a big bright that grin and chipper mood, she gets out of her chair and walks towards him in a staggering manner, trying to say something but the words are just not coming out, and you can tell that she's completely beside herself and she just sounds very confused and out of sorts. By now, Michael Shane himself, the detective on the show has realized something is wrong as his face changes radically from carefree, joyful mood to confusion and concern, and by now, the secretary has collapsed in Michael Shane's arm and she has fainted. So the viewer, then the camera pans and you can see that Michael Shane has lifted the secretary up and taking her to the sofa in the office and he is trying to wake her up.
What goes through your mind as the viewer at this point is, who was on the phone and why was she acting so strangely, and what does Michael Shane think of all this, and basically, what's going on? Nothing is clear. Now, at this point, there is a knock at the door and a young man delivers a large flower arrangement and continues to say that, “Too bad about that Shane fella, I hear he was a good guy.” Now, you can see Michael Shane stands up and walks towards the flower arrangement. He has this strange look on his face and he goes and reads the note that says, “Farewell, Michael.” At this point, the music kicks in and you know the mystery train just left at the station.
So this, all that I just described happens in 30 seconds, first 30 seconds of the show, and you know that in the next 40 to 50 minutes, the mystery’s going to unfold in you're going to find out what just happened or what's going to happen. So what are you thinking? You're formulating a theory and you begin to think, okay, so who sent the flowers and why does it imply that Shane is dead when he's not and you know that he knows he's not dead, and you know probably somebody set him up, and you know he knows he thinks he's set up. So this thinking that just happens in our head is what we're going to talk about today. So as I'm describing this to you, entire episode, this intro to the episode that I just summarized which really took us on this whirlwind of a ride in somebody's mind and we are thinking, we are constantly engaged in this process of who is thinking what? Who is feeling which way and why? And we use this knowledge to predict what each person is feeling and thinking, and we use that knowledge to eventually predict what each person is going to do that we are interacting or observing. Finally, we too begin to formulate the start about who's the murderer or what is the mystery about, and as more and more clues come our way, we begin to solve this mystery and we kind of know that he probably is going to suspect somebody but they're not going to be the real murderer. Eventually, we’re going to need to figure out who is who, and this brings me to our guest today.
So getting into people's head and figuring out what's going on in there is a gift that we take for granted. This ability to infer minds of others makes us social beasts and mind-reading machines, but rarely this part of daily conversation, let alone being a discussion of intervening, intervention for executive function challenges. So today, I hope to bring attention to this topic called Theory of Mind which deeply influences student's ability or patient’s ability, or individual’s ability to advocate for themselves, understand how they will be perceived and received by others, and finally, know how they need to adjust their social selves to belong to a small group or work cooperatively, or persuade others to join in the mission of personal success, and this with great joy, I introduce you to our speaker, her name is Dr. Carol Westby.
She is a speech and language pathologist and an educational consultant, and honestly, one of my personal favorite experts in Theory of Mind and social communication impairments. She has written and presented workshops nationally, internationally on the Theory of Mind, play, language literacy development, and learning disabilities, and most importantly, her work in multicultural issues is also extremely relevant in today's society. She has received the honors of the association award from ASHA which is American Speech & Hearing Association. Carol has an undergraduate degree in chemistry but eventually, she moved towards speech and language pathology field when she had a dean of students, I think, who happened to encourage her to consider this as a wonderful field and it has been a gift to my profession, I feel honestly. Her work, particularly with the retarded citizens program with led to developing of the play scale which is a very important tool for evaluating proficiency and children. She's a true expert in translating research into simple message of practical application and I am very excited to introduce you all to Carol Westby.
Producer: Well, Sucheta, I should have known that you would have drawn lessons on helping us better understand executive function through a detective mystery, should have known. This is going to be a great conversation. Looking forward to it. Let's get to it.
Here is Sucheta's conversation with Dr. Carol Westby.
Sucheta: Welcome to the podcast, Carol, it's my privilege and honor to have you. Let me jump right into the meat of this conversation today. What is Theory of Mind and what are the dimensions of it, and why is it so pivotal to human interactions and social success?
Dr. Carol Westby: First, what is Theory of Mind? I think the first use of that term was in 1978 when Premack and Woodruff published their article, Does a Chimpanzee Have a Theory of Mind? and in that article, they did find it, it's this ability to think or know what someone else was thinking or knowing and believing, and to realize that what they thought and knew, and believed was different than what you thought, and knew, and believed, and that people act on what they think, know, and believe. Now, I term that definition of Theory of Mind Cognitive Theory of a Mind, knowing, believing, thinking. In the middle of the early first decade of 2000, they worked in social neuroscience, they increased technology where we could actually look at people's brains while they were processing information, gave us information that we realized that Theory of Mind was not a unitary concept. I became aware particularly of the work of Simone Shamay-Tsoory, a young social neuroscientist out of Israel and she had done a study. She took adults that had brain damage, localized brain damage, either a tumor, or a penetrating wound, a stroke, and so CT scan, she knew exactly where the damage was, and then she generated different types of tasks that would assess some different types of Theory of Mind, and her tasks were assessing either what she called cognitive theory of mind it, what does someone know, believe, or think, and affective theory of a mine, what does someone feel? What are their emotions in the situation? So she came up with tasks that look very similar. One of them, she has these - just kind of little figures, all the people had to do was point to the figure, so it would be, “Yanni is thinking about.
..” and you see a little face and you'd see Yanniçs eyes looking in one of four directions. “Yanni is thinking of…” and even very young children know to follow gaze and even a typical five-year-old will follow Yanni's gaze and thinking, “Oh, Yanni's and thinking about the shark. That's what he's looking at,” So that was cognitive Theory of Mind. So there were a number of tasks like that. Then, she changed only one word in those Yanni tasks. Same thing, little face of Yanni in the middle with his eyes looking towards something, only this time, she said, “Yanni loves…” Oh, he loves the Mr. Potato Man toy. That's what he's looking at. What she found was depending upon where the neurological damage was, people could do one or not the other. People, in order to do the Cognitive Theory of Mind task, you had to have the temporal parietal juncture and you had to have the dorsal medial frontal lobe to handle the thinking. For the affective ones, you needed the orbital frontal gyri. So then she was saying, alright, we have both cognitive and affective Theory of Mind. Before that time and if you look at the research that's been done on Theory of Mind, if it's early 2000s, earlier, when they talked about Theory of Mind, they did not make the distinction between cognitive and affective so you have to be alert to that when you're reading some of the research articles. So she has established there's both cognitive and affective and that's been well-established now by many other individuals with a variety kinds of tasks.
Sucheta: A couple of things if you can clarify for those who have actual no exposure on understanding of Theory of Mind, but this is the ability that allows us to really see that if I love vanilla ice cream and there's chocolate and vanilla, some people actually may not like vanilla so it's a good idea to have chocolate because they may go for chocolate. So this influences the way we for example, shop or when we're having a party, what kind of food we choose, or it kind of also - perspective when they are in a conversation, what information we tell people, not assume that they already know, right? Those are the ways it influences? Can you comment a little bit on that?
Dr. Westby: You're understanding that someone else might think something differently than I do. So if we go to an amusement park, I had one of my friends who was going to hit every roller coaster ride in the park. It's like, not my choice. So what do I like, what do you like, and being aware of that. You have to know that with friends. Do we like the same thing? I like animals but a young woman I'm good friends discovered she was absolutely terrified of any animal. So I realized, when I'm out, if kind of a dog is coming up, my reaction might be to pet it if it's lucky, but I realized if with her, I'll get it in between us and make sure the animal doesn't get too close to her and I won't go near it because I know she's terrified of any kind of animal even though I wouldn't be. So all of our interactions and understanding your emotional interactions. If I get really excited about something, if I don't have a affective Theory of Mind, let's say for the roller coaster. So I'm looking at it and I'm kind of frowning and kind of shaking because my friend Joan says, “We're going to go on this,” and I have to be able to realize, she's looking excited but she has to look at me and realize I am not thrilled at this, and so she has to realize she has to say, “It'll be okay. I'll sit on the outside. We won't sit upfront. I really want to be upfront but I know you don't want to be upfront,” and so all of your negotiations with peers involves, does she think the same way I do and does she feel the same way I do? And for friendships to work, you have to realize that your thoughts and feelings are different because you often have to accommodate for those different thoughts and feelings.
Sucheta: Beautiful. And I think that's why, as you made a very important point, that until 2000, there was no distinction. So Shamay’s work is important because she actually showed that not only it’s processed differently, but it's located differently, located in different parts of the brain, but particularly, we know certain groups of people who actually have deficits in one and not the other. So bringing logical understanding to know what people feel and think, and believe has no bearing on the way they monitor or change their ways while dealing or accommodating, or negotiating that space with people, right?
Dr. Westby: Right, right, exactly.
Sucheta: So tell me, how does this relate to executive function? And I'd also love to see if you can kind of tie this into different terminologies that have been weaved into the fabric of this conversation such as Theory of Mind that eventually people have referred, like Baron Cohen has talked about mentalizing or rather mind reading, and then Chris Frith has talked about mentalizing. Are these different concepts or are they the same?
Dr. Westby: There's so many different vocabulary terms that are used across both Theory of Mind and executive function. I would say the terms mentalizing being the same - well, I would see it would kind of involve cognitive Theory of Mind. I'm going to go into a little more detail. I think the different dimensions of Theory of Mind, so we have Cognitive and Affective Theory of Mind. The affective, this will get a bit confusing because within affective, we have two aspects. We have cognitive affective which is knowing how someone else feels, knowing how I feel, so it's cognitive knowledge of the emotions, then there is affective empathy, okay? So under affective theory of mine, we have affective cognitive, cognitive knowledge, but then we have a affective empathy, and that's that emotional response before we even cognitively process what's happening. Humans come kind of pre-programmed with this affective empathy. It's why when one baby in the nursery cries, they all start crying. That's affective empathy. When we see someone in sudden pain, we'll have an emotional response before we fully process what's happening. That's affective empathy. That's somewhere different part of the brain too. We now believe it's influenced by our mirror neurons, those sort of come in the inferior frontal lobe, they have direct connections into the limbic system. So then when we are looking at cognitive and affective Theory of Mind, and I've made a reference, Theory of Mind refers both to what I'm thinking someone else is thinking and feeling, but my own knowledge of what I think and feel. So now, we differentiate cognitive and affective out into interpersonal, my ability to think about what you're thinking, knowing, believing, and feeling, and my ability to reflect on my own knowledge and feelings. Now, here is where that intrapersonal Theory of Mind - intra, within myself, involves executive function, and here's where it can be kind of confusing. The research is confusing on this. Some researchers who are really into executive function say you need executive function to have Theory of Mind, and other people say no, you first start becoming aware of yourself and that develops executive function. Clearly, whatever is going on, there is a tremendous overlap between the two. The research varies depending on what age they look at these relationships, what executive function tasks they look at, but clearly, that intrapersonal Theory of Mind is very much overlapped with executive function, and in fact, if you look at the research on executive function where they talk about hot and cold executive function -
Sucheta: Yes, I know, yeah.
Dr. Westby: Yeah. Cold executive function is handled in the parts of the brain that are involved in cognitive Theory of Mind and those cold executive functions are things that don't have emotionality to it. So it's completing like that little Tower of Hanoi task where you have to move the little circles over the different pegs and get them all stacked up. That takes some planning and thinking but you're usually not emotionally upset over this. That's different than the marshmallow experiment where there's one marshmallow. If you let it alone until I come back, you'll get two. That's considered a hot executive function task because you're looking at that marshmallow and you're smelling it, and you really want it right now. The hot tasks - executive function tasks involve more orbital frontal areas. The cold tasks, more temporal parietal and dorsal, medial frontal. So there's a tremendous overlap. Clearly, executive function and intrapersonal Theory of Mind - I don't even know if I would totally distinguish them. In some ways, I kind of see them as one and the same because intrapersonal Theory of Mind, what do I know? What don't I know? How am I feeling? You got to register all of that to implement executive function. Now, here's where we throw in another term because you can have executive functions that are outside of your awareness. So even if we say executive function involves the ability to inhibit, it involves working memory, it involves flexibility, most of the time, you're not thinking about that. As soon as you start actively thinking about it, you're engaging metacognition. It's interesting; the work in metacognition arrose exactly at the same time as Cognitive Theory of Mind but for many years, the two sets of researchers were in totally different camps. They're kind of not even aware they were really talking about the same thing.
Sucheta: Yes, and it's the same thing I find that now that I'm talking to different researchers, in education, they're talking about behavior self-control, for example, in one place, it's called self-regulation, another another place, it's called self-control. The third place, it's called impulse control, but they are talking about this fundamental ability of regulating one's own behaviors or emotions, or thinking but people believe that they are almost addressing different sets of skills from different parts of the brain, but you're kind of showing this framework, how they are tied together and one must really think like that because that's how we're going to manage it better too, right?
Dr. Westby: Well, and if we're looking at when we're trying to get kids to consciously self-regulate, I now look at that, I have to develop their intrapersonal Theory of Mind. I have to help them reflect on what they're thinking and knowing. If you're in a situation and you don't know that you don't know something, there's no reason to regulate yourself. You have to realize that they are expecting something of you and right now, you don't know, and how do I go about getting that information? So I've got to start attending, I've got to start looking for appropriate things. If you don't have a Theory of Mind, the ability to reflect on your own knowledge and how you feel about this, there is no basis for trying to develop these explicit executive function skills.
Sucheta: Yeah, and another thing if I may add, what I find, that the entire premise particularly in young development and through education, if the teacher observes something, she is being the medium of expression of that observation and there is assumption made that what I see in you is what you will see in you based on my feedback to you which is verbal, and that doesn't work. It does not lead to self regulation.
Dr. Westby. No. Oh, that is so, so critical. Now, here, I know I'm kind of jumping into intervention but there's a program out there and I think it has a lot of useful points, the zones of regulation, where you get the youngster thinking, are you in the red zone or the green zone, or the blue zone? What I'm finding is that teachers are teaching the kids the language and they come back with a language which you realize they have no idea of how it maps on them. It's just the teacher in this situation says, “Here are the words you use,” and they come back with these words but it's not a cognitive knowledge themselves. They are not really consciously aware of what they're feeling and thinking. They're learning to mimic the words of the teachers, and so we kind of talk about, okay, what's even a lower level? If you want to use that program, there are scales we have to teach before you can use that program.
Sucheta: Can you take a minute to elaborate on this intrapersonal Theory of Mind particularly as you distinguish between affective and cognitive aspects of it? How do we understand self-awareness and then awareness of awareness? Is there any difference between these two abilities and what is the developmental trajectory when students, when children become more proficient at it?
Dr. Westby: Again, when we look at the intrapersonal Theory of Mind, we have the two components, the cognitive -do I know if I know this? Sheldon Cooper's really good example of these two aspects of intrapersonal. He has some cognitive interpersonal Theory of Mind. He knows he's a brilliant physicist. He knows what he knows. He also knows that he's not good with social skills. So he has that cognitive intrapersonal Theory of Mind. He has next to no affective. Cognitively, he knows he does not have the effective so there's a really good [25:26] where his girlfriend Amy has broken up with him and he gets himself a cat. Well, his roommate Leonard understand why he's got that cat but Sheldon doesn't. Leonard comes home this day and there is Sheldon with five cats and Leonard said, “Look, I mean, one was bad enough - five cats.” “Oh, cats are just great.” Leonard says, “No. Do you realize what's happened? You are sad because Amy's broken up with you.” “No, no, I just like cats.” “No, I understand, you are sad. My aunt had cats. She was lonely. You're feeling lonely, that's why you have the cats.” He has no ability to connect. He's feeling something but he doesn't understand. He can't adequately talk about the feeling, express it, even when Leonard tries to explain it, he doesn't quite get it. It's been interesting watching those people grow over the years. In one of their recent episodes, he and Penny are playing a game, if you could have anything in the world, what would it be? and Penny says, “I wish I could be as smart as you guys,” and that Sheldon initially says, “Yeah, you wish,” but then he says, “You know, if I could have anything, I wish I could read minds,” and Penny -
Sucheta: That's so beautiful.
Dr. Westby: A fortune teller? And he said, “No.” He said, “You could do something I can't.” He said, “You always know how someone feels and I don't know and I can't figure that out, and I really wish I could.” So he has some cognitive awareness of what he's missing. So there's that cognitive intrapersonal. He has severe deficits in the affective. He's not good at reading someone else's but he's also not good at realizing when he melts down, why he melts down or what he could do about it. All his friends around him tried providing the scaffolds to help him deal with his emotional meltdowns.
Sucheta: Well, that brings us to the end of our conversation, but before I let you go, I was wondering if you can make a commentary on how does this become such an important avenue for people to relate to each other and what happens when this is a deficit, or is there a gradation here because is this - not everybody with these kinds of disabilities has a disorder but I see in my daily interactions so many people who lack these abilities to read minds of others, understand cognitively or affectively what's going on in the heads of others and adjust themselves so they can create more cooperative environments for themselves?
Dr. Westby: Well, if you can't do that, it's going to disrupt social interactions. You can't even carry on a good conversation unless you're able to realize what the other person's talking about, how they're thinking and feeling about it so that your comments are relevant. Without this, conversation it's difficult, any kind of problem solving. It also affect your reading comprehension, particularly with narratives because authors don't explain everything that's going on in someone's head. So it's clearly critical at that point, but all of this is on a continuum and even people we call ‘neurotypical people’ have quite a range of these skills. In recent years, we've discovered that there are certain genetic alleles that make you more prone to picking up on this information than other alleles, and it turns out, if you're in a good environment, let's say you have some of those allelles that just aren't good at this. If you're in a good environment, it doesn't have much effect. If you're in a bad environment where you're raised by people where there's not socialization, you don't have good care, people aren't reading your cues, giving you feedback, responding to you, then even though you started with a neurotypical brain, you end up not being as good at this. So there's a tremendous range in people. Well, I mean, we kind of joke and realized that mathematicians - Baron Cohen talks about this - mathematicians, engineers aren't quite as good at this as people who go into education and social work. People are logical but some of them are better at this than others and people who tend to be a little better [30:33] Theory of Mind are more likely to go into professions where they have to use it more. If you're not quite as good, you tend to gravitate to things where you don't need that interaction. It's not as critical for you accomplishing your work. So yes, tremendous variation within even neurotypical people of where they are on this continuum, and then our increasing understanding of these genetic variations that underline some of these difference -
Sucheta: Well, that - keep going, I'm sorry.
Dr. Westby: Well, it's just environment and I think later, we'll talk more about this but environment can also impact how good you are at this or how poor. It starts really overlapping with the genetic component.
Sucheta: Well, this is a phenomenal discussion. Thank you so much for sharing your wisdom and giving us a framework. I find that when I work with executive function training, if I do not build the skills in the domain of Theory of Mind, their ability to transfer and utilize skills to become better advocates or have relationships where their dysregulation which impacts other people, you can lessen the impact of that because people are judging your competence and your cooperativeness based on how well you manage yourself and if you fail to manage and show no awareness of it, it can be very damaging to your social success.
Dr. Westby: So you can't adjust implement those executive function programs and assume that kids will use those strategies if they don't have the awareness of their own thinking and emotionality at the moment. They don't know how to choose among those strategies.
Sucheta: Exactly. Well, thank you so much for coming on the show, Carol. I really look forward to the second part of this interview and I'm going to invite you to come back again so you can share best practices as well as ways to provide intervention and help promote these skills. So thank you once again.
Dr. Westby: Alright, thank you for the opportunity.
Producer: Alright. Wow, Sucheta, great conversation with the Dr. Carol Westby. Sure is some of your initial thoughts about this conversation.
Sucheta: Thank you, Todd. It's a wonderful thing that you and I get to banter at the end and I get to share some of the thoughts that come to mind as I reflect back.
So let me start with this idea that all human beings naturally long to be understood and we feel fulfilled when others do understand in return. We gravitate towards understanding other human beings through this process of reading minds. We are not just interested in understanding them but we want to use that knowledge so that we can have a better understanding of how they are going to behave based on how they feel, what they believe in, what their desires are. So researchers and scientists only became aware of this very pervasive human ability as of recent as you heard Carol talk about and only after they begin to study autism, but we have begun to kind of even develop a deeper and deeper understanding of this. Theory of Mind as we heard is not a theory as the word might suggest which kind of doesn't do justice but it's more like a theory or intuitive guess of what happens inside the minds of others. This is a sign of awareness that people have inner lives and the truth about people's inner lives must be considered as we interact with them because their inner lives is robustly influencing the way they are going to behave and you taking a minute to think about their inner lives is going to impact your relationship with them. So an autism expert Uta Frith describes this as an invisible GPS in the brain that allows us to navigate the social world around us. This important social tool gives us as an advantage. It helps as compare people's actions with our theory and what we have inferred to be true or not, and when the intentions and beliefs that we have inferred or extrapolated match with people's actions, then we actually conclude that we are on the right track. When they don't, in fact, that accesses the pause button and then we readjust our theory and we kind of look for more clues, why did I miss it? I thought she was happy with this choice but she looks very unhappy. I didn't see that coming. So you see, Theory of Mind is the uncanny ability to let us track what someone knows and gauge what someone feels, and then in return, I mean, we turn that around and use that knowledge to act a certain way ourselves, to respond to that situation in a different way than initially we may have planned to do without that knowledge, and this is the secret sauce that makes us socially successful, and this is the reason I feel it's so important that every clinician, every parent, every boss, every teacher needs to have a deep understanding of theory of mind because that is pretty much influencing the way we redirect people or tolerate people. I hate the conversation always goes in the direction of "Let's manage people,” “Let's do conflict resolution,” but if you look at the conflict resolution breakdown or break down during conflicts is basically people feeling to read minds of others.
Producer: So thinking about this, I noticed that theory of mind it has obvious benefits, and frankly, very obvious disadvantages when these skills are absent, right, Sucheta?
Sucheta: Of course, and what's so interesting, one of the finest qualities a human being develops is the ability to lie and this ability to lie is a shared product of strong Theory of Mind. It's the mentalizing ability that allows us to lie. For example, we sprinkle daily interactions with tiny lies. We lie to protect others from so-called the truth, okay? We veil the true feelings that we have to protect our vulnerabilities. We lie to compliment somebody. We lie to hide the real reasons behind our actions. So social etiquettes and politeness rules are just structured to do nothing but protect others from getting hurt, so saying thank you when you receive a blue car - toy car - from your grandmother when you hate cars is a good way to protect grandma from her feelings getting hurt and when, of course, the lack of mentalizing or of waiving the knowledge of Theory of Mind can create social disadvantage of where people speak without a veil and these people then develop a huge nakedness in a social context that they tell it like it is or they often disclose thoughts of other people which were veiled intentionally by somebody. So it's like saying, my children picking up the phone, this used to happen of course, you've seen this in older shows. Now, it's cell phones, so not so often but picking up the phone and saying, a ten-year-old say on the phone that, “My mom wants me to tell you that she is in the shower when she's sitting right here.” So revealing what the truth is without putting the veil on it to protect people in conversations is absent and that can create a huge disadvantage, and this disadvantage actually becomes such a sore point in social communication that you don't want to hang out with the person with poor Theory of Mind skills because that person is going to rat you out. This person is going to behave as if he doesn't got your back, he's going to act as if he doesn't understand the social drama that's going on, and so in fact, this person is going to become a disadvantage to your own social progress. Am I making sense?
Producer: Making perfect sense, Sucheta, and I know you know that I have a mother in late-stage dementia, Alzheimer's, and there is no way for me to engage with her socially without a bunch of little white lies. I mean, It's the only way we can engage in a relationship with her. I'm not saying that in a mean snarky way. You understand that disease, it's the only way we can survive in a relationship with her that has any semblance of normalcy and pleasantness, so I get it.
So closing this conversation, walk us through how you would connect executive function to Theory of Mind.
Producer: Yeah, that's a very good point. I think I have defined executive functions in this prodcast many times but here you go. One more time, I'm going to take the liberties to explain, but executive function skills refer to the set of skills or processes that are essential to control and execute complex behaviors. They include things like planning, working memory, maintaining and shifting a mental set in a flexible manner, and inhibiting a response when a different response is called upon. This is particularly important, this process of executive control is particularly important in novel situations where a same old routinized response need to be replaced with a novel response because situations have undergone small changes. Theory of Mind allows you to judge what has changed, and what has changed is, the inner life of people has changed. So two people are in conversation and suddenly - I'll give you an example. My brother came into town yesterday and we went out for dinner and he was talking about a very interesting situation that happened in his company. A very senior director was called from India to do training for this massive project, multimillion-dollar project for the company, and to welcome him, they had a small get-together with the client as well as the company partners here in this country, in US, and during the evening, this was as my brother and I, pleasantly described was an FOB - fresh-off-the-boat - he had never lived in the US. He had visited it a couple of times but as a tourist, and so he needed to be in US for several years to complete this, execute this project and supervise it and he was in charge of 30,000 people. So imagine the scope of this project, and so he gets introduced to the client and imagine, they're having a conversation and this fellow from India who's FOB - just fresh off the boat - begins to talk about where he's going to live in the city and he openly begins to talk about not so-and-so neighborhood and not so-and-so neighborhood, definitely not that neighborhood because such-and-such population lives there - and you know what he's referring to - and this racial bias that he carried with him came from a place of ignorance but also failing to read what is appropriate at work place. My brother and I were laughing about this because he and I grew up in a household where we were advised that if you're not sure, don't say it and don't expose yourself, and so this man, in three, four back-to-back conversational references made reference to African-American population and his views about it which projected of course, nothing but racist attitude and preconceived notions that were not portraying the company in a favorable, and that night, his boss got a phone call that the man from India was asked to return back to India and the project was retracted.
So this is the danger that exists when you don't have the capacity to deploy your executive function using the Theory of Mind knowledge which is I should not do, the impulse control, what should I do instead? Of planning, how do I respond to somebody who's critical of me? How do I say something when somebody is not cooperating with me? Those are the things that go into executive function management using Theory of Mind.
So the most important thing I want our listeners to take away from this conversation is that Theory of Mind delays in children or actual deficits in developing Theory of Mind are quite pervasive than one can imagine, so often, this is associated with autism spectrum disorder but in fact, they are quite evident in many, many developmental disorders, including social communication disorders, language impairment disorders, traumatic brain injury, ADHD, Parkinson's disease, dementia - as you mention, your mom's case - and behavioral and psychiatric condition. So in childhood, if it's not detected in a timely way and if children don't receive appropriate support and intervention, they can become these adults who don't have the skills that make them employable or make them easily become part of a larger community. So we run big risks in not addressing Theory of Mind and that's why I think it's really, really important to take time to understand Theory of Mind.
Producer: Yeah, it's what you just said. I was just thinking that you can't engage in a workplace if you have poor skills here. Fascinating stuff.
All right, that's all the time we have for today. On behalf of our host Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today. We look forward to seeing you again next week with our second conversation with Dr. Carol Westby. We’ll see you next week.