Joumal of Autism and Developmental Disorders, Vol. 26, No. 5, 1996
Brief Report: Morality in the Autistic Child^
R. James R.
University College London and Medical Research Council Cognitive Development Unit
INTRODUCTION
The suggestion that children with autism are unresponsive to the socioaffective cues of those around them, that they lack empathy, is an old
and widespread idea (e.g.. Frith, 1989; Gillberg, 1992; Kanner, 1943). According to Kanner's (1943) description, people "figured in about the same
manner as did the desk, the bookshelf, or the filing cabinet." Sigman,
Kasari, Kwon, and Yirmiya (1992) found that autistic children were behaviorally unresponsive to adults showing distress, fear, and discomfort in seminaturalistic settings. However, children with autism may not be so
unresponsive to the socioaffective cues of those around them. Wing and
Gould (1979) reported that the social impairment of children with autism
need not manifest itself in the avoidance of social contact as Kanner (1943)
described. They noted that some children with autism were merely passive
or even actively sociable in a peculiar fashion. Also, Yirmiya, Sigman,
Kasari, and Mundy (1992) found that while autistic children were mildly
impaired relative to normally developing controls on the Feshbach and
Powell Audiovisual Test for Empathy (Feshbach, 1982), they did perform
"surprisingly well."
^This research was conducted in partial fulfillment of the requirements for the Doctor of
Philosophy degree at University College London. During the writing up of this report James
Blair was supported by Wellcome Mental Health Training Fellowship 37132/2792/2/1.4Q. I
am grateful to the children, parents, and staff of Broomhayes, Castlebar, Doucecroft,
Harborough, Heathlands, Helen Allison, Spring Hallow, Sybil Elgar, Tornhill Park, and
Whitefield schools. I am also grateful to Francesca Happ6 for her assistance in data collection.
In addition, I thank John Morton, Lisa Cipolotti, Heinz Wimmer, Francesca Happ6 and
Chris Mitchell for their comments on earlier drafts. Portions of this article were presented
at the 1993 meeting of the British Psychological Society (Developmental Section).
^Address all correspondence to James Blair, Department of Psychology, University College
London, Gower Street, London WCIH OHT, England.
571
0:62-3257/96/100O-O571$09.50/0 © 1996 Plenum Publishing Corporation
572
Blair
Autism has been associated with a deficit in the Theoiy of Mind
(ToM) also referred to as the ability to mentalize (e.g., Baron-Cohen,
Leslie, & Frith, 1985; Frith, 1989). It is thought that children with autism
cannot represent the mental states of others; their thoughts, beliefs, wishes,
and desires. Children with autism have been shown to fail belief tests that
require the subject to represent another's mental state (e.g., Baron-Cohen
et al., 1985). for example, the Sally-Anne task involves the subject representing a story character's false belief that an object is in one location when
it is actually in another.
Frith (1989) and Gillberg (1992) have both claimed that it is the impairment in the ability to mentalize that is the cause of the autistic children's apparent lack of responsivity to the socioaffective cues around them.
Both have suggested that there are no primary affective deficits in autism
(i.e., that the child with autism should show affective responses to the distress of others). However, both Frith (1989) and Gillberg (1992) have suggested that without the capacity to mentalize, the child will be unable to
respond adequately to the emotional states of others. Thus, Gillberg claims
"If you do not understand that other people have, as it were, inner worlds,
how can you be expected to show compassion or empathy" (p. 835; italics
as in the original text).
One of the markers of a developing responsivity to the distress of
others in the normal developing child is the emergence of the moral/conventional distinction (Blair, 1995; Smetana, 1985). The moral/conventional
distinction is the distinction that children and adults make in their judgments between moral and conventional transgressions (Smetana, 1993).
This distinction is made from the age of 39 months (e.g., Smetana &
Braeges, 1990) and is found across cultures (e.g.. Song, Smetana, & Kim,
1987). Within the literature, moral transgressions (e.g., hitting another,
damaging another's property) are defined by their consequences for the
rights and welfare of others. Conventional transgressions (e.g., talking in
class, dressing in opposite-sex clothes) are defined by their consequences
for the social order. Children and adults generally judge moral transgressions to be more serious then conventional transgressions (see Smetana,
1993). In addition, and more important, modifying the rule conditions (e.g.,
by an authority figure removing the prohibition against the act) only affects
the permissibility of conventional transgressions. Even if there is no rule
prohibiting the action, subjects generally judge moral transgressions as nonpermissable. In contrast, if there is no rule prohibiting a conventional transgression, subjects generally judge the act as permissible (see Smetana,
1993).
It is crucial to note that it is the presence of victims that distinguishes
moral and conventional transgressions. If a subject considers that a trans-
Morality in the Autistic Child
573
gression will result in a victim, he/she will process that transgression as
moral. If subject does not consider that a transgression will result in a victim, he/she will process that transgression as conventional. Thus, Smetana
(1982) has shown that whether an individual treats abortion as a moral
transgression or conventional transgression is determined by whether
he/she judges the act to involve a victim or not. Similarly, Smetana (1985)
has found that unknown transgressions (specified by a nonsense word) were
processed as moral if they were associated with causing victims, conventional if they were not.
The present study sought to investigate the responsivity of children
with autism to the distress of others through their responses to the
moral/conventional distinction. Two groups of children with autism were
investigated. One group failed the two false belief tasks presented to them
(the no-ToM group) and can be considered to lack the ability to mentalize
(e.g., Happe, 1994). The second group passed the two false belief tasks
(the first-order group) and may have acquired the capacity to mentalize
(e.g., Baron-Cohen, 1989). Two contrasting sets of predictions can be
made: First, if children with autism are sensitive to the distress of others
then even the no-ToM group should make a significant moral/conventional
distinction. Second, if mentalizing is a prerequisite for sensitivity to the
distress of others, then the no-ToM group should not make a significant
moral/conventional distinction and significant group differences should be
seen.
METHOD
Subjects
Twenty children with autism took part in this study. These subjects
were contacted either via special schools for autistic children or via a clinician who knew of children with autism in the community. All of the subjects had previously received a diagnosis of autism according to DSM-III-R
criteria by clinicians independent of the present study. These subjects were
divided into two groups on the basis of their performance on a battery of
false belief tasks. The first group of subjects (n = 10) did not pass either
the Sally-Anne or Smarties false belief tasks; this is the no-ToM group.
The second group of subjects (n = 10) passed both false belief tasks; this
is the first-order group. As control groups there were 10 normally developing children and 10 Moderate Learning Difficulty (MLD) children. The
normally developing children and the MLD children were controls for the
no-ToM group. All subjects (other than the normally developing children
574
Blair
Table I. Means and Ranges for Each of the Subject Criteria"
Age (years)
VMA
VIQ
8.3
6,6-9,4
-
-
Mild learning difficulty children
M
Range
11.1
10,0-12,7
6.9
6,3-7,9
68.1
58-75
No-ToM children with autism
M
Range
11.6
8,3-17,1
7.4
6,3-8,11
71.0
56-91
First-order children with autism
M
Range
14.6
11,1-17,6
10.8
7,9-19,0
79.5
59-125
Group
Normal developing children
M
Range
"No-ToM children with autism = children with autism who do not pass any false
belief tests; first-order children with autism = children with autism who pass false
belief tests; VMA = verbal mental age; VIQ = verbal IQ. Ag ranges in years,
months.
and 1 of the first-order group^) were given the British Picture Vocabulary
Scale (BPVS) to assess Verbal Mental Age (VMA). Full subject characteristics are shown in Table I.
Two false belief tasks were used to assess the mentalizing ability of
the subjects with autism; the Sally-Anne task of Baron-Cohen et al. (1985)
and the Smarties task of Perner, Frith, Leslie, and Leekam (1989). For the
Sally-Anne task a set of three small cardboard boxes of different sizes,
shapes, and colors served as hiding places, a one-pence piece was the object
hidden, and Sally and Anne were Playmobil characters. For the Smarties
task, a Smartie tube containing a pen top was used.
The stories used to measure he moral/conventional distinction were
all taken from the literature (see Smetana, 1993). The four moral stories
involved (1) a child hitting another child; (2) a child pulling the hair of
another child and the victim crying; (3) a child smashing a piano; and (4)
a child breaking the swing in the playground. The four conventional stories
involved (1) a boy child wearing a skirt; (2) two children talking in class;
(3) a child walking out of the classroom without pennission; and (4) a child
who stops paying attention to the lesson and turns their back on the
teacher. All stories were set within a classroom setting other than moral
story 4 and conventional story 1 which were set in a playground setting.
'This subject was given the WAIS.
Morality in the Autistic Child
575
All props to aid story telling were Playmobil. During the stories, the adult
teacher was represented by an "adult" Playmobil character and the children
were represented by "child" Playmobil characters.
Procedure
Subjects were tested in a quiet room. Story props were always spread
out on a table in front of the subjects. The procedures described by BaronCohen et al. (1985) for the Sally-Anne task and by Perner et al. (1989)
for the Smarties task were followed. The order of presentation of the false
belief tasks was randomized across subjects. Presentation of both false belief tasks took no longer than 10 minutes. If the subject failed both tasks,
he/she was considered a member of the no-ToM group. If the subject
passed both tasks he/she was considered a member of the first-order group.
The procedure for assessing the subject's moral/conventional distinction followed the classic paradigm (e.g., Smetana, 1985). The subject was
told a story using the Playmobil characters. This study would involve a rule
(either moral or conventional) being broken. At the end of the story, the
characters would be left in their final resting places (e.g., "talking" to each
other or hitting each other). The order of presentation of the various transgressions was randomized across subjects. After the story had been told
the subject was asked the following questions:
1. Was it O.K. for [the story character] to do [the transgression]?
(ascertaining the children's judgment of the permissibility of the act)
2. Was it bad for [the story character] to do [the transgression]? (ascertaining the children's judgment of the seriousness of the act)
The Playmobil characters were then placed back in their original positions and the subject was told: "Now what if the teacher said before the
lesson, before X did Y, that "At this school anybody can Y if they want
to. Anybody can Y." The Playmobil teacher character was moved as he
spoke and a different tone of voice was attempted by the experimenter.
The child was then asked a final question:
3. Would it be O.K. for X to do Y if the teacher says X can? (ascertaining the children's judgment of authority jurisdiction*)
Only yes/no responses were acquired. All responses were recorded by
hand on a standard scoring sheet. Presentation of all of the transgression
The authority jurisdiction question was chosen in preference to any of the other modifiability
questions because this question sets up a concrete setting (the teacher saying this). It does
not ask the chiid to imagine a country where there was no rule or just what if there was no
ruie. It was felt that these questions might be too abstract for the autistic subjects.
576
Blair
Stories usually took no longer than 10 minutes. All subjects completed all
of the stories. No subjects were dropped from the study.
Scoring Procedure
The scoring procedure followed that commonly used in the literature
(e.g., Smetana & Braeges, 1990). The answers to both questions were
scored categorically. Yes responses were assigned a score of 0, and no (not
OK) responses a score of 1.
RESULTS
Mean responses were calculated for each domain of story for each
of the three questions (see Table II). Three 4 (Group) x 2 (Domain) splitplot ANOVAs performed on the responses for all three questions. There
were main effects for domain for both permissibility, F{1, 3) = 9.73, p <
.005; seriousness, F(l, 3) = 15.38, p < .001; and authority jurisdiction, f (1,
3) = 77.12, p < .001. There were no significant effects for group or for
any significant interactions; all of the groups were making the moral/conTable II. Means and Standard Deviations for Each of the Criterion Judgments for Each
of the Subject Groups"
Criterion judgments
Permissibility
Group
M
Seriousness
Authority jurisdiction
C
M
C
M
C
Normal developing children
M
0,975
SD
0.08
0.925
0.12
0,025
0,08
0,25
0,17
0,85
0,17
0,30
0.33
Mild Learning difficulty children
M
0,975
SD
0,08
0.90
0,17
0,00
0,00
0,05
0,11
0,80
0,31
0.425
0,39
No-ToM children with autism
M
0,925
SD
0.17
0,78
0.25
0,025
0.08
0,15
0,27
0,875
0,13
0,35
0,27
First order children with autism
M
1.00
SD
0,00
0,80
0,28
0.10
0.32
0,20
0.28
0,925
0.17
0.45
0.35
"No-ToM children with autism = children with autism who do not pass any false belief tests;
first-order children with autism = children with autism who pass false belief tests; M =
moral; C = conventional; a "no" response scores, 1, a "yes" 0,
Morality in the Autistic Child
577
ventional distinction for all of the questions presented to them. Crucially,
a one-way repeated measures ANOVA showed that the no-ToM group of
children with autism were making a significant moral/conventional distinction on the authority jurisdiction question, F(l, 9) = 26.64; p < .001.
DISCUSSION
The present study examined the ability of the child with autism to
make the moral/conventional distinction. This study found (a) that the children with autism made a distinction between moral and conventional transgressions in their judgments; (b) that level of ability on false belief tasks
is not associated with the tendency to distinguish moral and conventional
transgressions; even the least able of the groups of children with autism
were recognizing the moral/conventional distinction.
The finding that the children with autism investigated in the preset
study made the moral/conventional distinction indicates that at least these
children with autism are sensitive to the distress of others. According to
Smetana (1982; 1985), an individual's processing of an act as moral or conventional is determined by whether he/she considers that the act results in
victims. Blair (1995) has argued that a prerequisite for the development of
the moral/conventional distinction is the emotional capacity to show arousal
to the distress of others. Support for this notion comes from the study of
adult psychopaths. Psychopathy, like autism, is a developmental disorder
associated with a lack of empathy (Hare, 1991). Adult psychopaths do not
show arousal to the distress of others (Aniskiewicz, 1979; House & Milligan, 1976) and do not make the moral/conventional distinction (Blair, 1995;
Blair, Jones, Clark, & Smith, 1995). This suggests, in line with Frith (1989)
and Gillberg (1992), that there are no primary affective deficits in autism.
In support of this, children with autism have been found to show significant
arousal responses to the distress of others (Blair, 1996). The lack of empathic behavior sometimes noted in children with autism would therefore
be attributed to the mentalizing deficit (see Frith, 1989; Gillberg, 1992).
Two caveats to the above conclusions should be considered: First,
even the no-ToM children with autism were relatively high functioning
(VIQ = 56-91). While it has been found that IQ is not related to
moral/convention distinction performance (see Smetana, 1993), it is possible that children with autism with IQs/verbal skills lower than those in the
present study might not pass the moral/conventional distinction. The second
caveat concerns the development of the moral/conventional distinction. The
finding that even the no-ToM group of children with autism, who can be
considered to lack the ability to mentalize, made a significant moral/con-
Blair
578
ventional distinction seems to support Blair's (1995) view that the ability
to mentalize is not a prerequisite for the general development of the distinction. However, it is more than possible, that the ability to mentalize is
a prerequisite for the development of the understanding of the moral nature of some rules (e.g., lying and stealing). Thus, the child with autism
may not process as moral those transgressions (e.g., stealing) that require
an individual to represent the mental state of another in order to realize
that the other is a victim.
The present study provides preliminary evidence that at least relatively high-functioning children with autism do show some sensitivity to the
distress of others. In addition, the finding that those children with autism
who failed both false belief tests presented to them, and who thus may
lack the ability to mentalize, made a moral/conventional distinction indicates that the ability to mentalize is not a prerequisite for the development
of the distinction.
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