Some people think only intellect counts: knowing how to solve problems, knowing how to get by, knowing how to identify an advantage and seize it. But the functions of intellect are insufficient without courage, love, friendship, compassion and empathy. - Dean Koontz, Novelist

In 1978, Premack and Woodruff asked the question, "Does a chimpanzee have a theory of mind?" defining theory of mind (ToM) as the ability to attribute mental states-beliefs, intents, desires, pretending, knowledge, and so forth-to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one's own. Thus was initiated the beginning of what is now 36 years of research on ToM. The ToM construct has been associated with persons' abilities to interact appropriately with one another (Lerner, Hutchins, & Prelock, 2011; Liddle & Nettle, 2006). Implementation of the Common Core Standards in schools has focused attention on developing children's and adolescents' intellectual abilities to bring about improved academic performance. As Koontz states, however, intellect or cognitive skills are not sufficient without affective abilities, including empathy. And in fact, students with better social skills perform better academically (Durlak, Weissberg, Dymnicki, Taylor, Schellinger, 2011).

The traditional view of ToM is that it is a unitary construct dependent on cognitive abilities. Until the early 2000s, most of the ToM research was at the behavioral, psychological, or cognitive level-How persons performed when given tasks that required them to reflect on the knowledge, thoughts, and beliefs of others. With technologies developed in the late 20th century and the advent of social neuroscience, however, research has shown that ToM is a multidimensional construct, having both cognitive and affective dimensions with empathy as an aspect of the affective dimension (Dvash & Shamay-Tsoory, 2014). Empathy provides a mechanism for triggering courage, love, friendship, and compassion. The movie critic Roger Ebert has said, "I believe empathy is the most essential quality of civilization" (Ebert, 2010).

This construct of the multidimensional nature of the ToM bookends this issue of Topics in Language Disorders (TLD). In the first article, neuroscientists Dvash and Shamay-Tsoory (2014) describe the multidimensional nature of ToM, and in the final article, speech-language pathologists Westby and Robinson (2014) describe how the multidimensional ToM construct can be used in assessment and interventions for persons with ToM deficits. The intent of this issue of ToM is to present current conceptions of ToM from multiple perspectives: biological, environmental, linguistics, manifestations of ToM deficits and implications of the multidimensional ToM construct for assessment and intervention.

Dvash and Shamay-Tsoory (2014) set a theme for this issue of TLD by providing the biological or neuroanatomical basis for ToM. The work of Shamay-Tsoory and her colleagues provide evidence that ToM is a multidimensional rather than a unitary construct. On the basis of a number of functional magnetic resonance imaging studies from their own work and the work of others (Abu-Akel & Shamay-Tsoory, 2011; Shamay-Tsoory & Aharon-Peretz, 2007; Shamay-Tsoory, Aharon-Peretz, & Perry, 2009; Shamay-Tsoory, Hararib, Aharon-Peretz, & Levkovitzbet, 2010; Shamay-Tsoory, Tibi-Elhanany, & Aharon-Peretz, 2007), they present neurophysiological evidence for ToM as a multidimensional construct comprising cognitive and affective dimensions. Cognitive ToM involves the ability to think about or infer the thoughts, beliefs, and intentions of others, as well as the ability to reflect on one's own thoughts, beliefs, and intentions. Affective ToM involves thinking about the emotions of others and oneself.

Dvash and Shamay-Tsoory (2014) further differentiate affective ToM into two dimensions: cognitive affective ToM (or cognitive empathy), which involves consciously recognizing and thinking about emotions, from affective empathy, which is the largely unconscious and automatic ability to respond to the emotions of others. They indicate that affective empathy typically involves implicit processing in contrast to cognitive ToM and cognitive affective ToM, which involve primarily explicit processing. Dvash and Shamay-Tsoory (2014) give particular attention to the role of affective empathy in social interactions.

Theory of mind can also be differentiated in terms of whether one is thinking about one's own thoughts and emotions (termed intrapersonal ToM) or thinking about the thoughts, beliefs, and emotions of others (termed interpersonal ToM). By acknowledging these multiple dimensions of ToM, researchers and service providers can better interpret results of ToM studies that sometimes appear conflicting. Although many of the authors in this issue of TLD do not explicitly refer to these specific ToM dimensions, they all do acknowledge the complex multidimensional nature of ToM.

Stanzione and Schick (2014) approach ToM from an environmental perspective, explaining how environmental factors and the resulting experiences children have with language and conversation influence their ToM development. Using evidence from children who are deaf or hard of hearing, children with language impairments, and children from lower socioeconomic backgrounds, they document how these children have fewer experiences with conversational interactions using mental state and emotion terms and less exposure to the complex syntactic structures used when talking about mental states and emotions.

These reduced or disrupted conversational interactions, influence not only the age at which children pass classic ToM tasks but also emergence and quality of their autobiographical memory. Autobiographical memory is "explicit memory for specific points in the past, recalled from the perspective of the self in relation to others" (Nelson & Fivush, 2004, p. 488). How mothers reminisce with their preschool children about shared past experiences is clearly related to the quantity and quality of their children's autobiographical memory.

Autobiographical memory involves a sense of self through time. A conscious sense of self involves an intrapersonal ToM. Reminiscing may be particularly critical in helping children to understand that mental states and emotions exist over time. By relating the past in elaborated and detailed ways, mothers may be helping their children construct more detailed representations of past events that may, in turn, help children link previous mental states to current internal states and behaviors. Mothers who are more elaborative during reminiscing have children with a more advanced understanding of mind (Reese & Cleveland, 2006). Related to this, mothers who talk more about mental states during reminiscing have children who come to talk more about their own past mental states later in development (Rudek & Haden, 2005), suggesting that children are learning how to describe their own and others' mental states, both past and present, in the context of mother-child reminiscing. It is also possible that, as mothers are reminiscing, they are also empathizing with their children about experiences. Greenspan (2007) claims that "Empathy comes from being empathized with. The more empathy your child sees, the more socially competent he'll become" (p. 43).

Many studies show that performance on classic ToM assessments is closely tied to language, particularly syntactic skills (Astington & Baird, 2005). Given this relationship between ToM and language, it is critical that those assessing and intervening with persons with ToM deficits know just what aspects of language to assess and develop. Like Dvash and Shamay-Tsoory (2014), de Villiers and de Villiers (2014) distinguish between implicit and explicit ToM. Frith and Frith (2008) were among the first to propose that social cognition involves implicit and explicit processes. Implicit processes operate in parallel and are fast and largely automatic and unconscious processes. In contrast, explicit processes are slow, sequential, and conscious. Using language to explicitly reason through formal ToM tasks allows for a deliberate consideration or a judgment of others' mental states. In everyday social interactions, an implicit form of ToM reasoning allows for correct action anticipation of a persons' behavior, without deliberately reflecting on his or her mental or emotional states. Language provides an explicit way to process ToM tasks. de Villiers and de Villiers (2014) explain the characteristics of the vocabulary and syntactic structures associated with explicit ToM processing. Persons possessing these language structures may be able to use them to compensate for difficulties they may have with implicit processing of social cognition. de Villiers and de Villiers (2014) agree with Stanzione and Schick (2014) regarding the importance of conversational interactions in promoting ToM. They further maintain that adults should give attention to the specific types of syntactic structures they use in these interactions.

Theory of mind deficits have particularly been associated with autism spectrum disorders (ASDs). Kimhi (2014) provides a broad view of ToM in persons with ASD, particularly high-functioning ASD and Asperger's syndrome. She discusses ToM development across the life span in persons focusing on the social and academic manifestations of ToM that are critical for everyday life skills. She considers social manifestations of ToM in symbolic play, conversation, and autobiographical memory and academic manifestations of ToM in reading comprehensions, narrative skills, and writing abilities. Kimhi frames her review and discussion in terms of implicit and explicit ToM tasks and abilities. She acknowledges that many high-functioning persons with ASD are able to use language to pass classic ToM tasks, even high-level ToM levels, yet they continue to exhibit difficulties in social interactions. She explains this discrepancy in terms of explicit and implicit processing.

Theory of mind deficits have been widely acknowledged in persons with autism, language impairments, deafness, and hearing loss. They are recognized in persons with traumatic brain injuries (Dennis et al., 2013) and are documented in persons with psychiatric conditions (Baron-Cohen, 2011) and degenerative neurological conditions such as Parkinson's disease and dementias (Freedman & Stuss, 2011). Less is known about the ToM abilities of students who receive an educational diagnosis of emotional disturbance (or the equivalent medical diagnosis of disruptive behavior disorder). To the diagnostic criteria for disruptive behavior disorders, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013) has added specifiers for callous-unemotional traits. The description of these traits reflects deficits in interpersonal and intrapersonal affective cognitive ToM and affective empathy.

Noel and Westby (2014) review the literature on language deficits in youths with emotional behavior disorders or disruptive behavior disorders and youth offenders, many of whom have a diagnosis of emotional behavioral disorders. A meta-analysis of 22 studies that investigated language skills in children aged 5-13 years with a diagnosis of emotional behavioral disorder revealed that 81% of them exhibited significant language impairments as assessed on standardized language assessments (Hollo, Wehby, & Oliver, 2014). Studies of adolescent youth offenders have indicated that 66%-90% have below average language scores, with 46%-67% having low to very low scores (Bryan, Freer, & Furlong, 2007; Snow & Powell, 2005, 2008).

Noel and Westby (2014) describe manifestation of ToM deficits in narratives produced by these adolescents. They note that both narratives and social problem solving require ToM abilities. Both narratives and social problem solving require recognition of persons' thoughts and emotions in response to problems, their intentions to deal with the problems, and their evaluations of the outcomes of their attempts to deal with the problems. Because of this apparent relationship between narratives and problem solving, Noel and Westby describe a narrative intervention program to develop ToM and promote social problem solving.

Using the multidimensional ToM construct described by Dvash and Shamay-Tsooory (2014) and developmental data on ToM, Westby and Robinson (2014) developed a protocol for assessment of ToM skills. Using this framework, along with what is known about language and conversational interactions that promote ToM, they present a hierarchy of activities to foster explicit and implicit ToM development. They emphasize that their goal is not to teach persons to pass ToM tasks but to develop the foundational skills essential for appropriate social interactions, which ultimately must involve empathy. They address the language skills that not only underlie explicit ToM abilities but also engage children and adolescents in conversations and playful interactions that have the potential to develop the implicit processing of multiple cues in the environment essential for using ToM in daily social activities.

In the Xhosa culture of South Africa, there is a word, ubuntu, that, when roughly translated, means "a person is a person because of other persons." One cannot exist as a human being in isolation. The ubuntu ideology emphasizes the importance of empathy, sharing, and cooperation in efforts to resolve problems. Ubuntu might be viewed as the societal manifestation of ToM. Like ubuntu, ToM develops only through interactions with others. And with adequate development of all dimensions of ToM, particularly affective empathy, persons have the potential to be interconnected with and compassionate toward other persons. The goal of interventions seeking to promote development of ToM must go beyond teaching the skills to pass structured ToM tasks to laying the foundations for ubuntu.

-Carol Westby, PhD

Issue Editor

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