Reading the Mind in the Eyes Test (2001) - AQA PDF

J. Child Psychol. Psychiat. Vol. 42, No. 2, pp. 241–251, 2001 Cambridge University Press...

J. Child Psychol. Psychiat. Vol. 42, No. 2, pp. 241–251, 2001 Cambridge University Press ' 2001 Association for Child Psychology and Psychiatry Printed in Great Britain. All rights reserved 0021–9630\01 $15.00j0.00 The ‘‘ Reading the Mind in the Eyes ’’ Test Revised Version : A Study with Normal Adults, and Adults with Asperger Syndrome or High-functioning Autism Simon Baron-Cohen, Sally Wheelwright, Jacqueline Hill, Yogini Raste, and Ian Plumb University of Cambridge, U.K. In 1997 in this Journal we published the ‘‘ Reading the Mind in the Eyes ’’ Test, as a measure of adult ‘‘ mentalising ’’. Whilst that test succeeded in discriminating a group of adults with Asperger syndrome (AS) or high-functioning autism (HFA) from controls, it suffered from several psychometric problems. In this paper these limitations are rectified by revising the test. The Revised Eyes Test was administered to a group of adults with AS or HFA (N l 15) and again discriminated these from a large number of normal controls (N l 239) drawn from different samples. In both the clinical and control groups the Eyes Test was inversely correlated with the Autism Spectrum Quotient (the AQ), a measure of autistic traits in adults of normal intelligence. The Revised Eyes Test has improved power to detect subtle individual differences in social sensitivity. Keywords : Theory of mind, Asperger’s Disorder, autistic disorder, social cognition. Abbreviations : AQ : Autism Spectrum Quotient ; AS : Asperger syndrome ; HFA : high- functioning autism ; TS : Tourette’s syndrome. A challenge for psychology is to develop tests that are in ’’ to their mental state. For this reason, we described it sensitive to subtle cognitive dysfunction. This is par- as an ‘‘ advanced theory of mind test ’’. ‘‘ Theory of mind ’’ ticularly important in the domain of social cognition. is shorthand for the ability to attribute mental states to There is a wealth of basic-level social cognitive tests for oneself or another person (Premack & Woodruff, 1978), use with young children (Flavell, Green, & Flavell, 1986 ; and this ability is the main way in which we make sense Flavell, Shipstead, & Croft, 1978 ; Wellman, 1990 ; of or predict another person’s behaviour. Theory of mind Wimmer & Perner, 1983). However, there are few tests is also referred to as ‘‘ mentalising ’’ (Morton, Frith & that can measure if an adult with normal intelligence may Leslie, 1991), ‘‘ mind reading ’’ (Whiten, 1991), and have a mild deficit in social understanding. Researchers ‘‘ social intelligence ’’ (Baron-Cohen, Jolliffe, et al., 1999), in adult neuropsychology have developed some tests of and overlaps with the term ‘‘ empathy ’’. Examples from face perception (Young, Hellawell, De Wal, & Johnson, the first version of the test are shown in Figs. 1 and 2. 1996), but often in the case of patients with acquired A task analysis of the Eyes Test might include the brain damage the deficits are gross rather than subtle. In following : The subject needs to have a mental state contrast, in neurodevelopmental conditions such as lexicon and know the semantics of these terms. The Eyes autism or Asperger syndrome, deficits in social cognition Test then involves mapping these terms to fragments of may persist across the lifespan. These may, however, facial expressions of mental states—just the part of the be camouflaged as a result of learning compensatory face around the eyes. At a reportedly unconscious, rapid, strategies. Without a subtle and sensitive test, the investi- and automatic level, subjects must match the eyes in each gator might erroneously conclude that the patient is picture to examples of eye-region expressions stored in ‘‘ recovered ’’ or ‘‘ normal ’’. memory and seen in the context of particular mental In our first efforts towards developing an adult test of states to arrive at a judgement of which word the eyes social sensitivity, we described the ‘‘ Reading the Mind in most closely match. Note that the Eyes Test is described the Eyes ’’ Test (Baron-Cohen, Jolliffe, Mortimore, & as an advanced test of theory of mind but in fact only Robertson, 1997). In this test, the participant is presented involves the first stage of attribution of theory of mind : with a series of 25 photographs of the eye-region of the attribution of the relevant mental state (e.g. compassion). face of different actors and actresses, and is asked to It does not include the second stage : inferring the content choose which of two words best describes what the person of that mental state (e.g. compassion for her mother’s in the photograph is thinking or feeling. This test was loss). However, attribution of the type of mental state is conceived of as a test of how well the participant can put nevertheless part of theory of mind, even if it is not all of themselves into the mind of the other person, and ‘‘ tune it. The results of this test showed that adult males in the general population scored a mean of 18n8 (SD l 2n5) Requests for reprints to Simon Baron-Cohen, Department of whereas women scored slightly but significantly higher, Experimental Psychology, University of Cambridge, Downing with a mean of 21n8 (SD l 1n8). Adults with high- Street, Cambridge CB2 3EB, U.K. functioning autism (HFA) or Asperger Syndrome (AS) (E-mail : SB205!cus.cam.ac.uk). performed significantly worse than sex-matched normal 241 242 S. BARON-COHEN et al. Figure 1. An example of a (male) stimulus used : in the first version word choices were serious (correct) vs. playful. In the revised version the word choices were serious (correct), ashamed, alarmed, and bewildered. Figure 2. A second (female) example from the Eyes Test : in the first version the word choice was reflective (correct) vs. unreflective. In the revised version the word choice was reflective (correct), aghast, irritated, and impatient. controls, or adults with a Tourette’s syndrome (TS) (a This is too narrow. Ideally, a test such as this would have different psychiatric condition, and included as an ad- a wider range, in order to be able to identify individual ditional control group). Thus, the adults with HFA or AS differences with greater power. scored on average 16n3 out of 25 (SD l 2n9), whereas the (2) When the first version of the test was given to adults with TS scored on average 20n4 out of 25 (SD l parents of children with AS, they too scored below the 2n6). Although this was only a 4-point difference, it was general population level (Baron-Cohen & Hammer, significant at the p n01 level. The group with TS did not 1997). This had been predicted on the basis that they differ significantly on this test from the general popu- might have the ‘‘ broader phenotype ’’ (Bailey et al., lation. 1995), since one or both of such parents might be carrying Thus, we had succeeded in developing a test of social the genes for autism. However, parents scored at a similar sensitivity or mind-reading that was able to reveal subtle level to people with HFA or AS (fathers scoring on mind-reading difficulties in adults with HFA or AS. This average 17n3 out of 25 (SD l 1n6), and mothers scoring a had been predicted on the basis of more basic mind- mean of 18n9 (SD l 2n1), even though they did not have reading deficits in younger children with autism (Baron- the condition themselves. This highlights that the test has Cohen, 1995). This was also of interest because it too narrow a range of scores to be able to distinguish demonstrated that normal adults could judge mental between someone with the ‘‘ lesser variant ’’\‘‘ broader states from even minimal cues (expressions around the phenotype ’’ (e.g., in a first-degree relative of someone eyes alone). Having established that the ability to ‘‘ read with autism), and someone with the condition itself. the mind in the eyes ’’ was testable, we considered in what (3) The narrow range of scores that are significantly ways the test could be improved. above chance on the first test can lead to a score in the normal range being close to the ceiling of the test. Ceiling Problems with the Original Version effects are obviously undesirable because one loses power of the Test to detect individual differences. There are two simple modifications we can make to the (1) The first version of the task involved a forced choice test to remedy these three limitations : increase the between only two response options (the two words number of items in the test, and increase the number of presented), so chance performance on each trial is p l n5. response options on each trial. In the revised version of Across the test as a whole one would therefore need to the test reported in this paper, we have made both of these score 17 or above out of 25 to be significantly above modifications : the total number of items (photographs) is chance (Binomial Test). This meant that the range of increased from 25 to 36, and the number of response scores in which the test can reveal individual differences options (forced-choice words) is increased from 2 to 4 per whilst still being above chance is only 9 points (17–25). trial. This means that chance is p l n25 per trial, and that  ‘‘ READING THE MIND IN THE EYES ’’ TEST 243 one only needs to score 13 or above, out of 36, to be concern with a group of patients with HFA in whom performing significantly above chance (Binomial Test). there will have been language delay. In the revised version In effect, this provides a bigger window of 24 points (from of this test, we rectified this problem by including a 13–36) in which to be able to reveal individual differences glossary of all the mental state terms, which subjects were in ability on this test. It also decreases the risk of normal encouraged to consult in any case where they were unsure performance approaching the ceiling of the test. of a word. (4) The first version of the test included both basic and complex mental states, and so contained some items that The study below reports data from the revised version were too easy, and which therefore risked producing of this test, and had several additional aims. (1) To test a ceiling effects. Basic emotions are happy, sad, angry, group of adults with AS or HFA on the revised version of afraid, and disgust. They are basic because they are the test. This was in order to check if the deficit in this recognised universally ; because they can be recognised group of patients that had been found on the original purely as emotions, without the need to attribute a belief version (Baron-Cohen, Jolliffe, et al., 1997) and related to the person ; and because they are recognised even by tests (Baron-Cohen, Wheelwright, & Jolliffe, 1997) could very young normally developing children (Ekman & be replicated. (2) To test if in a sample of normal adults, Friesen, 1971, Harris, 1991 ; Walker, 1982). Complex an inverse correlation would be found between per- mental states in contrast involve attribution of a belief or formance on the Eyes Test (Revised) and the Autism intention—a cognitive mental state—to the person. In the Spectrum Quotient (AQ) (Baron-Cohen & Wheelwright, revised version of the test we limited the items to complex in press). The AQ measures the degree to which any mental states so as to make the task that much more individual (adult) of normal IQ possesses traits related to challenging, and in this way increasing the likelihood of the autistic ‘‘ spectrum ’’ (Wing, 1988). The AQ is a self- obtaining a greater range of performance in a random report questionnaire. Scores range from 0–50, and the sample of adults. higher the score, the more autistic traits a person pos- (5) In the original version, there were some items that sesses. (3) To test if the sex difference (female superiority) could be solved simply by checking the gaze direction of found on the first version of the test (Baron-Cohen, the face. The words for such items were ‘‘ noticing ’’ or Jolliffe, et al., 1997) replicated. ‘‘ ignoring ’’, etc., (mental states linked to perception), such that gaze-direction might be all that a participant needed to attend to in order to arrive at the correct Method answer. This could be too easy a clue for someone with a Subjects subtle mind-reading difficulty. These are therefore excluded in the revised version of the test. Table 1 shows the four groups of subjects tested. (6) The original version had more female faces than Group 1 comprised adults with AS or HFA (N l 15, all male). They were recruited via adverts in the U.K. National male faces, and it was unclear if this may have biased the Autistic Society magazine, or equivalent support groups. They test in some way. In the revised version of the test, this had all been diagnosed in specialist centres using established was carefully controlled by having an equal number of criteria (American Psychiatric Association, 1994 ; World Health male and female faces in the photographs. The advantage Organisation, 1994). They spanned an equivalent range of of this was that it allowed a control condition—judging socioeconomic classes and educational levels as seen in Group gender from the eyes—to be closely matched to the 2. They were all given the short WAIS-R (Wechsler, 1939) experimental condition—judging mental states from the comprising the Block Design, Vocabulary, Similarities, and eyes. Picture Completion, and all scored in the normal range (mean (7) In the original version of the test the target word l 115, SD l 16n1). and its foil were always semantic opposites (e.g., con- Group 2 comprised normal adults (N l 122) drawn from cerned vs. unconcerned, or sympathetic vs. unsympa- adult community and education classes in Exeter, or from public library users in Cambridge. They had a broad mix of day- thetic), again making the test too easy. The test essentially time occupations ranging from unemployment through manual was asking the participant to distinguish chalk from and clerical workers, to professionals. They also had a broad cheese, or black from white—in this case, asking them to mix of educational level, some having no education beyond distinguish between mental states of opposite emotional secondary school, others having either occupationally related valence (positive vs. negative). In the revised version of training, or college degrees. Data on age was available for N l the test we have again increased the level of difficulty by 88 of these. ensuring that as far as possible the three foil words have Group 3 comprised normal adult students (N l 103, 53 male, the same emotional valence as the target word. For 50 female) all studying for undergraduate degrees in Cambridge example, if the target word was ‘‘ serious ’’, the foil words University (71 in science, 32 in other subjects). Since this might be ‘‘ ashamed ’’, ‘‘ alarmed ’’, and ‘‘ bewildered ’’. university has very stringent entrance requirements (typically three grade As at Advanced Level [school leaving] examination), This effectively means that a person has to distinguish the this group is not representative of the general population and correct target word from three close imposters, on each they can be assumed to have high IQ. trial. As such, we are testing the ability to distinguish Group 4 comprised randomly selected individuals in the shades of gray, or different types of cheese, as it were, so general population (N l 14) who were IQ matched with Group as to add to the challenging nature of the test, thereby 1 (mean l 116, SD l 6n4). Groups 1 and 4 did not differ maximising the possibility of revealing subtle individual significantly or IQ, or on age. See Table 1. differences. Figures 1 and 2 show two examples of pictures taken from the original test but with the new choice of four words with each. Procedure (8) Finally, given that the Eyes Test involves mapping Subjects in all four groups were tested on the revised adult a word to a picture, it is unclear if comprehension Eyes Test, as described earlier. This was individually adminis- problems with the words themselves might have contri- tered in a quiet room in Cambridge or Exeter. Subjects in the buted to an individual’s score. This is particularly a AS\HFA group were also asked to judge the gender of each 244 S. BARON-COHEN et al. Table 1 Subject Characteristics Chronological age IQ N Mean SD Mean SD Group 1 AS\HFA adults 15 29n7 14n5 115 16n1 Group 2 General population controlsa 88 46n5 16n9 — — Group 3 Students 103 20n8 0n8 — — Group 4 IQ-matched controls 14 28n0 9n0 116 6n4 a N l 122 for Eyes Test. Table 2 B) and indicate any word meanings they were unsure of. They Percentage of Subjects in Groups 2 and 3 Combined, Who were then encouraged to read these particular meanings and Chose Each Word on Each Item were told that they could return to this glossary at any point during the testing. Item Target Foil 1 Foil 2 Foil 3 1 31n6 1n8 26n2 40n4 Eyes Test Development 2 53n1 4n0 5n8 37n1 3 78n7 4n9 12n0 4n4 Target words and foils were generated by the first two authors 4 82n1 5n4 4n9 7n6 and were then piloted on groups of eight judges (four male, four 5 84n9 4n0 2n2 8n9 female). The criterion adopted was that at least five out of eight 6 79n6 1n3 8n0 11n1 judges agreed that the target word was the most suitable 7 79n9 7n6 10n3 2n2 description for each stimulus and that no more than two judges 8 79n5 3n6 13n8 3n1 picked any single foil. Items that failed to meet this criterion had 9 72n9 6n7 14n7 5n8 new target words, foils, or both generated and were then re- 10 74n7 12n9 8n9 3n6 piloted with successive groups of judges until the criterion was 11 83n6 4n9 8n9 2n7 met for all items. 12 48n4 34n7 13n3 3n6 The data from Groups 2 and 3 did not differ from each other, 13 68n4 20n4 8n4 2n7 so the results were combined, creating a sample of N l 225. 14 73n8 3n1 12n0 11n1 Table 2 shows the results of an item analysis on this combined 15 85n8 6n7 5n3 2n2 group. New criteria were applied to these data : at least 50 % of 16 72n9 7n1 4n0 16n0 subjects had to select the target word and no more than 25 % 17 86n7 6n2 5n3 1n8 could select any one of the foils. These criteria were arbitrarily 18 76n0 1n8 13n3 8n9 selected but with the aim of checking that a clear majority of the 19 79n6 9n3 4n0 7n1 normal controls selected the target word and that this was 20 63n4 18n8 16n1 1n8 selected at least twice as often as any foil. Items 1, 2, 12 and 40 21 68n3 10n3 4n5 17n0 failed to meet these criteria and were therefore dropped. 22 64n4 10n2 17n3 8n0 Subsequent analyses were carried out using the 36 items. Thus 23 88n0 5n3 6n7 0n0 target words were established on the basis of consensus from a 24 77n3 12n4 8n9 1n3 large population, since there is no objective method for 25 84n9 1n3 3n6 10n2 identifying the underlying mental state from an expression. The 26 80n9 0n4 4n0 14n7 complete list of target mental state words (in italic) and their 27 75n6 8n0 4n0 12n4 foils are shown in Appendix A. The glossary of mental state 28 64n9 5n8 21n8 7n6 terms is shown in Appendix B. 29 72n9 2n7 4n9 19n6 30 64n4 1n8 21n8 12n0 31 65n8 4n9 22n2 7n1 Predictions 32 71n9 16n5 0n9 10n7 Based on the previous studies we predicted that : 33 90n2 2n2 4n4 3n1 (1) The AS\HFA group would score significantly lower on 34 52n0 16n4 11n6 20n0 the mental state judgements on the Eyes Test, but be 35 60n4 10n2 23n6 5n8 unimpaired on the gender control judgements. 36 65n8 6n7 23n1 4n4 (2) The AS\HFA group would score significantly higher in 37 79n1 0n9 16n4 3n6 the AQ. 38 73n3 10n7 8n9 7n1 (3) Females in the ‘‘ normal ’’ groups (2 and 3) would score 39 81n3 0n9 2n2 15n6 higher than males on the Eyes Test. 40 60n0 3n1 26n7 10n2 (4) Males in the ‘‘ normal ’’ group (3) would score higher than females on the AQ. (5) Scores on the AQ and the Eyes Test would be inversely correlated. person in each photo, as a control task, given anticipated impairments on mental state recognition. Normal adults were found to be at ceiling on the gender recognition task during Results piloting so, to save time, were not required to do this task. In addition, subjects in Groups 1, 3, and 4 completed the AQ Subjects in the four groups did not differ in the number (Baron-Cohen & Wheelwright, in press). Finally, subjects were of words in the glossary that they were unsure of, and in asked at the outset to read through the glossary (see Appendix all subjects, the number of words checked never exceeded  ‘‘ READING THE MIND IN THE EYES ’’ TEST 245 Table 3 Performance on the Revised Eyes Test and AQ Eyes Test AQ N Mean SD Mean SD Group 1 AS\HFA adults All 15 21n9 6n6 34n4a 6n0 Group 2 General population controls All 122 26n2 3n6 — — Males 55 26n0 4n2 — — Females 67 26n4 3n2 — — Group 3 Students All 103 28n0 3n5 18n3b 6n6 Males 53 27n3 3n7 19n5c 6n7 Females 50 28n6 3n2 16n6d 6n1 Group 4 IQ matched controls All 14 30n9 3n0 18n9 2n9 a N l 14, due to 1 unreturned AQ. b N l 79, due to 24 unreturned AQs. c N l 47, due to 6 unreturned AQs. d N l 32, due to 18 unreturned AQs. Figure 3. Distribution of Eyes Test scores in Groups 2 and 3. two. Table 3 shows the means and standard deviations on than males, whilst the interaction was insignificant, the Revised Eyes Task for each of the four groups, and F(1, 224) l 0n79, p l n376. Separate group item analyses the results of the AQ for Groups 1, 3, and 4 only. A one- are shown in Table 4. All subjects with AS\HFA scored way ANOVA comparing the four groups on the Revised 33 or above out of 36 on the gender recognition control Eyes Task revealed that there was a significant main effect task. There were no within-group differences in Group 3 of group, F(3, 250) l 17n87, p l n0001. Further exam- (students) according to subject studied, F(1, 99) l 1n39, ination of this result using Scheffe! ’s tests indicated that, p l n24. as predicted, Group 1 performed significantly worse than On the AQ, as expected, Group 1 scored significantly the other three groups, who did not differ from each higher than Groups 3 and 4 : one-way ANOVA of group, other. This is shown graphically in Fig. 3. Sex differences F(2, 103) l 23n4, p l n00001 ; Scheffe! ’s tests indicated were examined in Groups 2 and 3, using an ANOVA of Group 1 scored significantly higher at the n05 level than GroupiSex. The sex difference approached significance, Groups 3 and 4, for which there was no difference. The F(1, 224) l 3n38, p l n067, with females scoring higher predicted sex difference on the AQ (males scoring higher 246 S. BARON-COHEN et al. Table 4 Item Analysis of the Eyes Test (Including Only the 36 Retained Items), Showing the Percentage of Each Group Passing Each Item Group 1 Group 2 Group 4 AS\HFA General population Group 3 IQ-matched Item adults controls Students controls (N l 15) (N l 122) (N l 103) (N l 14) 1 60n0 85n2 70n9 100n0 2 73n3 78n7 85n4 100n0 3 66n7 86n1 83n5 100n0 4 33n3 73n0 87n4 78n6 5 66n7 77n0 82n5 85n7 6 86n7 80n3 77n7 85n7 7 46n7 68n0 78n6 92n9 8 60n0 67n2 83n5 78n6 9 80n0 77n0 91n3 85n7 10 66n7 73n0 63n1 85n7 11 46n7 68n0 80n6 92n9 12 53n3 87n7 83n5 92n9 13 60n0 69n7 76n7 78n6 14 73n3 80n3 94n2 100n0 15 66n7 69n7 83n5 85n7 16 80n0 77n0 82n5 78n6 17 53n3 65n6 60n2 85n7 18 46n7 58n2 79n6 71n4 19 66n7 69n7 58n3 71n4 20 86n7 88n5 87n4 92n9 21 53n3 73n8 81n6 85n7 22 60n0 79n5 91n3 85n7 23 53n3 77n9 84n5 85n7 24 80n0 73n8 77n7 92n9 25 60n0 71n3 57n3 71n4 26 53n3 65n6 81n6 100n0 27 46n7 65n6 63n1 64n3 28 40n0 66n4 65n0 57n1 29 80n0 77n9 64n1 92n9 30 53n3 91n0 89n3 85n7 31 53n3 51n6 52n4 85n7 32 46n7 50n0 72n8 78n6 33 66n7 58n2 74n8 85n7 34 60n0 77n0 81n6 85n7 35 46n7 65n6 82n5 92n9 36 66n7 76n2 87n4 92n9 than females) in Group 3 was also found (t l 1n97, p l detect meaningful individual differences. This study n03 for one-tailed significance). Finally, the correlation replicated the earlier finding that adults with AS or HFA between AQ score, IQ score, and Eyes Test score was are significantly impaired on such tests, whereas they are computed. Combining the groups, there was no corre- not impaired on the gender recognition control test lation between the Eyes Test and IQ (r l n09, p l n6) (Baron-Cohen, Jolliffe, et al., 1997 ; Baron-Cohen, or between the AQ and IQ (r l n05, p l n77). The AQ Wheelwright, et al., 1997). This therefore validates it as a and Eyes Test were, as expected, inversely correlated useful test with which to identify subtle impairments in (r lkn53, p l n004). This was true for all three groups social intelligence in otherwise normally intelligent adults. where both measures were used. In the student group, the In a series of single case studies we have also found that Eyes Test was inversely correlated with the social skills this test distinguishes very high-functioning adults with category (r l n27, p l n015) and the communication AS\HFA from controls (Baron-Cohen, Wheelwright, category (r l n25, p l n027). Stone, & Rutherford, 1999). The Revised Eyes Test may be relevant to clinical groups beyond those on the autistic spectrum (e.g., brain-damaged patients following Discussion amygdalectomy or prefrontal cortical lesions). The test has recently been used with these groups (Stone, Baron- This study reports normative data on the Revised Eyes Cohen, & Knight, 1999 ; Stone, Baron-Cohen, Young, & Test for adults. The modifications were designed to Calder, 1998). We have recently developed a child version render this test a more sensitive measure of adult social of this test, reported separately (Baron-Cohen, Wheel- intelligence. As was hoped, the modifications from the wright, Spong, Scahill, & Lawson, in press). The adult original version led to normal performance being signifi- Eyes Test has been used during fMRI, revealing amygdala cantly below ceiling. This is important if the test is to do activity in the normal (but not in the autistic) brain more than discriminate extreme performance and instead (Baron-Cohen, Ring, et al., 1999).  ‘‘ READING THE MIND IN THE EYES ’’ TEST 247 In the present study, among the general population Syndrome. Journal of Child Psychology and Psychiatry, 38, controls and student group, there was a trend towards a 813–822. sex difference (female superiority) (p l n07). This echoes Baron-Cohen, S., Ring, H., Wheelwright, S., Bullmore, E., the sex difference found with the previous version of this Brammer, M., Simmons, A., & Williams, S. (1999). Social intelligence in the normal and autistic brain : An fMRI study. test. One possible reason why the sex difference did not European Journal of Neuroscience, 11, 1891–1898. reach significance with the new test is that if the effect size Baron-Cohen, S., & Wheelwright, S. (in press). The Autism- is relatively small, the chance of detecting a sex difference Spectrum Quotient (AQ) : Evidence from Asperger would be low. There was no significant correlation syndrome\high-functioning autism, males and females, between IQ and the Eyes Test, suggesting this is in- scientists and mathematicians. Journal of Autism and De- dependent of general (nonsocial) intelligence. velopmental Disorders. Performance on the Revised Eyes Test was inversely Baron-Cohen, S., Wheelwright, S., & Jolliffe, T. (1997). Is there correlated with performance on the Autism Spectrum a ‘‘ language of the eyes ’’ ? Evidence from normal adults and Quotient (AQ), suggesting that both measure degrees of adults with autism or Asperger syndrome. Visual Cognition, autistic traits across the notional spectrum (Wing, 1988). 4, 311–331. Baron-Cohen, S., Wheelwright, S., Spong, A., Scahill, V., & The AQ is not diagnostic but may serve as a useful Lawson, J. (in press). Are intuitive physics and intuitive instrument for quantifying the extent of an individual’s psychology independent ? A test with children with Asperger ‘‘ caseness ’’ in terms of AS\HFA, measuring personality syndrome. Journal of Developmental and Learning Disorders. traits. The present results confirm our earlier finding that Baron-Cohen, S., Wheelwright, S., Stone, V., & Rutherford, M. adults with HFA or AS score significantly higher on the (1999). A mathematician, a physicist, and a computer scientist AQ than do general population controls. with Asperger syndrome : Performance on folk psychology A criticism of the Revised Eyes Test might be that, even and folk physics test. Neurocase, 5, 475–483. with the new modifications, the stimuli are static, whereas Ekman, P., & Friesen, W. (1971). Constants across cultures in the real world never is. Future studies might usefully the face and emotion. Journal of Personality and Social employ dynamic stimuli of eye expressions. Static stimuli, Psychology, 17, 124–129. Flavell, J. H., Green, E. R. & Flavell, E. R. (1986). Devel- however, make the test quick and easy to use, since it can opment of knowledge about the appearance-reality distinc- be administered as a ‘‘ pencil and paper ’’ test. In our tion. Society for Research in Child Development, 51. laboratory, we are also experimenting with computer- Flavell, J., Shipstead, S., & Croft, K. (1978). Young children’s presentation of the Eyes stimuli so as to record response knowledge about visual perception : Hiding objects from time in subjects’ judgements of the most appropriate others. Child Development, 49, 1208–1211. mental state term to match each picture. Such speed of Morton, J., Frith, U., & Leslie, A. (1991). The cognitive basis of processing approaches may be a fruitful way to explore a biological disorder : Autism. Trends in Neurosciences, 14, individual differences on this task. However, it is clear 434–438. that even a nonautomated format is sufficient to reveal Premack, D., & Woodruff, G. (1978). Does the chimpanzee group differences. The Eyes test stands as an example of have a ‘‘ theory of mind ’’ ? Behaviour and Brain Sciences, 4, 515–526. how experimental methods can be applied to the social Stone, V., Baron-Cohen, S., & Knight, K. (1999). Frontal lobe domain. contributions to theory of mind. Journal of Cognitive Neuro- science, 10, 640–656. Stone, V., Baron-Cohen, S., Young, A., & Calder, A. (1998). Acknowledgements—SBC and SW were supported by the Patients with amygdalectomy show impairments in theory of MRC and the McDonnell Pew Foundation during the period of mind. Cambridge : University of Cambridge. this work. IP and YR submitted the normative data, which they Walker, A. S. (1982). Intermodal perception of expressive collected, as part of their final year project for the degree of BSc behaviours by human infants. Journal of Experimental Child in Psychology, University of Cambridge. JH collected the Psychology, 33, 514–535. normative data as part of her MSc in Psychological Research Wechsler, D. (1939). The measurement of adult intelligence. Methods at the University of Exeter. Baltimore, MD : Williams & Wilkins. Wellman, H. (1990). Children’s theories of mind. Cambridge, MA : MIT Press. References Whiten, A. (1991). Natural theories of mind. Oxford : Basil American Psychiatric Association (1994). DSM-IV Diagnostic Blackwell. and statistical manual of mental disorders (4th ed). Washing- Wimmer, H., & Perner, J. (1983). Beliefs about beliefs : ton, DC : Author. Representation and constraining function of wrong beliefs in Bailey, T., Le Couteur, A., Gottesman, I., Bolton, P., Simonoff, young children’s understanding of deception. Cognition, 13, E., Yuzda, E., & Rutter, M. (1995). Autism as a strongly 103–128. genetic disorder : Evidence from a British twin study. Psycho- Wing, L. (1988). The autistic continuum. In L. Wing (Ed.), logical Medicine, 25, 63–77. Aspects of autism : Biological research. London : Gaskell\ Baron-Cohen, S. (1995). Mindblindness : An essay on autism and Royal College of Psychiatrists. theory of mind. Boston : MIT Press\Bradford Books. World Health Organisation. (1994). International classification Baron-Cohen, S., & Hammer, J. (1997). Parents of children of diseases (10th ed.). Geneva : Author. with Asperger syndrome : What is the cognitive phenotype ? Young, A., Hellawell, D., De Wal, C., & Johnson, M. (1996). Journal of Cognitive Neuroscience, 9, 548–554. Facial expression processing after amygdalectomy. Neuro- Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. psychologia, 34, 31–39. (1997). Another advanced test of theory of mind : Evidence from very high-functioning adults with autism or Asperger Manuscript accepted 30 June 2000 248 S. BARON-COHEN et al. Appendix A List of Target Mental State Terms for Each Item (in Italic) and Their Distractors PIa jealous panicked arrogant hateful 1 playful comforting irritated bored 2 terrified upset arrogant annoyed 3 joking flustered desire convinced 4 joking insisting amused relaxed 5 irritated sarcastic worried friendly 6 aghast fantasizing impatient alarmed 7 apologetic friendly uneasy dispirited 8 despondent relieved shy excited 9 annoyed hostile horrified preoccupied 10 cautious insisting bored aghast 11 terrified amused regretful flirtatious 12 indifferent embarrassed sceptical dispirited 13 decisive anticipating threatening shy 14 irritated disappointed depressed accusing 15 contemplative flustered encouraging amused 16 irritated thoughtful encouraging sympathetic 17 doubtful affectionate playful aghast 18 decisive amused aghast bored 19 arrogant grateful sarcastic tentative 20 dominant friendly guilty horrified 21 embarrassed fantasizing confused panicked 22 preoccupied grateful insisting imploring 23 contented apologetic defiant curious 24 pensive irritated excited hostile 25 panicked incredulous despondent interested 26 alarmed shy hostile anxious 27 joking cautious arrogant reassuring 28 interested joking affectionate contented 29 impatient aghast irritated reflective 30 grateful flirtatious hostile disappointed 31 ashamed confident joking dispirited 32 serious ashamed bewildered alarmed 33 embarrassed guilty fantasizing concerned 34 aghast baffled distrustful terrified 35 puzzled nervous insisting contemplative 36 ashamed nervous suspicious indecisive aPI : practice item. Appendix B Glossary for Adult Eyes Test ACCUSING blaming The policeman was accusing the man of stealing a wallet. AFFECTIONATE showing fondness toward someone Most mothers are affectionate to their babies by giving them lots of kisses and cuddles. AGHAST horrified, astonished, alarmed Jane was aghast when she discovered her house had been burgled. ALARMED fearful, worried, filled with anxiety Claire was alarmed when she thought she was being followed home. AMUSED finding something funny I was amused by a funny joke someone told me. ANNOYED irritated, displeased Jack was annoyed when he found out he had missed the last bus home. ANTICIPATING expecting At the start of the football match, the fans were anticipating a quick goal. ANXIOUS worried, tense, uneasy The student was feeling anxious before taking her final exams. APOLOGETIC feeling sorry The waiter was very apologetic when he spilt soup all over the customer. ARROGANT conceited, self-important, having a big opinion of oneself The arrogant man thought he knew more about politics than everyone else in the room. ASHAMED overcome with shame or guilt The boy felt ashamed when his mother discovered him stealing money from her purse.  ‘‘ READING THE MIND IN THE EYES ’’ TEST 249 Appendix B (cont.) ASSERTIVE confident, dominant, sure of oneself The assertive woman demanded that the shop give her a refund. BAFFLED confused, puzzled, dumfounded The detectives were completely baffled by the murder case. BEWILDERED utterly confused, puzzled, dazed The child was bewildered when visiting the big city for the first time. CAUTIOUS careful, wary Sarah was always a bit cautious when talking to someone she did not know. COMFORTING consoling, compassionate The nurse was comforting the wounded soldier. CONCERNED worried, troubled The doctor was concerned when his patient took a turn for the worse. CONFIDENT self-assured, believing in oneself The tennis player was feeling very confident about winning his match. CONFUSED puzzled, perplexed Lizzie was so confused by the directions given to her, she got lost. CONTEMPLATIVE reflective, thoughtful, considering John was in a contemplative mood on the eve of his 60th birthday. CONTENTED satisfied After a nice walk and a good meal, David felt very contented. CONVINCED certain, absolutely positive Richard was convinced he had come to the right decision. CURIOUS inquisitive, inquiring, prying Louise was curious about the strange-shaped parcel. DECIDING making your mind up The man was deciding who to vote for in the election. DECISIVE already made your mind up Jane looked very decisive as she walked into the polling station. DEFIANT insolent, bold, don’t care what anyone else thinks The animal protester remained defiant even after being sent to prison. DEPRESSED miserable George was depressed when he didn’t receive any birthday cards. DESIRE passion, lust, longing for Kate had a strong desire for chocolate. DESPONDENT gloomy, despairing, without hope Gary was despondent when he did not get the job he wanted. DISAPPOINTED displeased, disgruntled Manchester United fans were disappointed not to win the Championship. DISPIRITED glum, miserable, low Adam was dispirited when he failed his exams. DISTRUSTFUL suspicious, doubtful, wary The old woman was distrustful of the stranger at her door. DOMINANT commanding, bossy The sergeant major looked dominant as he inspected the new recruits. DOUBTFUL dubious, suspicious, not really believing Mary was doubtful that her son was telling the truth. DUBIOUS doubtful, suspicious Peter was dubious when offered a surprisingly cheap television in a pub. EAGER keen On Christmas morning, the children were eager to open their presents. EARNEST having a serious intention Harry was very earnest about his religious beliefs. EMBARRASSED ashamed After forgetting a colleague’s name, Jenny felt very embarrassed. ENCOURAGING hopeful, heartening, supporting All the parents were encouraging their children in the school sports day. ENTERTAINED absorbed and amused or pleased by something I was very entertained by the magician. ENTHUSIASTIC very eager, keen Susan felt very enthusiastic about her new fitness plan. 250 S. BARON-COHEN et al. Appendix B (cont.) FANTASIZING daydreaming Emma was fantasizing about being a film star. FASCINATED captivated, really interested At the seaside, the children were fascinated by the creatures in the rock pools. FEARFUL terrified, worried In the dark streets, the women felt fearful. FLIRTATIOUS brazen, saucy, teasing, playful Connie was accused of being flirtatious when she winked at a stranger at a party. FLUSTERED confused, nervous and upset Sarah felt a bit flustered when she realised how late she was for the meeting and that she had forgotten an important document. FRIENDLY sociable, amiable The friendly girl showed the tourists the way to the town centre. GRATEFUL thankful Kelly was very grateful for the kindness shown by the stranger. GUILTY feeling sorry for doing something wrong Charlie felt guilty about having an affair. HATEFUL showing intense dislike The two sisters were hateful to each other and always fighting. HOPEFUL optimistic Larry was hopeful that the post would bring good news. HORRIFIED terrified, appalled The man was horrified to discover that his new wife was already married. HOSTILE unfriendly The two neighbours were hostile towards each other because of an argument about loud music. IMPATIENT restless, wanting something to happen soon Jane grew increasingly impatient as she waited for her friend who was already 20 minutes late. IMPLORING begging, pleading Nicola looked imploring as she tried to persuade her dad to lend her the car. INCREDULOUS not believing Simon was incredulous when he heard that he had won the lottery. INDECISIVE unsure, hesitant, unable to make your mind up Tammy was so indecisive that she couldn’t even decide what to have for lunch. INDIFFERENT disinterested, unresponsive, don’t care Terry was completely indifferent as to whether they went to the cinema or the pub. INSISTING demanding, persisting, maintaining After a work outing, Frank was insisting he paid the bill for everyone. INSULTING rude, offensive The football crowd was insulting the referee after he gave a penalty. INTERESTED inquiring, curious After seeing Jurassic Park, Huge grew very interested in dinosaurs. INTRIGUED very curious, very interested A mystery phone call intrigued Zoe. IRRITATED exasperated, annoyed Frances was irritated by all the junk mail she received. JEALOUS envious Tony was jealous of all the taller, better-looking boys in his class. JOKING being funny, playful Gary was always joking with his friends. NERVOUS apprehensive, tense, worried Just before her job interview, Alice felt very nervous. OFFENDED insulted, wounded, having hurt feelings When someone made a joke about her weight, Martha felt very offended. PANICKED distraught, feeling of terror or anxiety On waking to find the house on fire, the whole family were panicked. PENSIVE thinking about something slightly worrying Susie looked pensive on the way to meeting her boyfriend’s parents for the first time. PERPLEXED bewildered, puzzled, confused Frank was perplexed by the disappearance of his garden gnomes. PLAYFUL full of high spirits and fun Neil was feeling playful at his birthday party.  ‘‘ READING THE MIND IN THE EYES ’’ TEST 251 Appendix B (cont.) PREOCCUPIED absorbed, engrossed in one’s own thoughts Worrying about her mother’s illness made Debbie preoccupied at work PUZZLED perplexed, bewildered, confused After doing the crossword for an hour, June was still puzzled by one clue. REASSURING supporting, encouraging, giving someone confidence Andy tried to look reassuring as he told his wife that her new dress did suit her. REFLECTIVE contemplative, thoughtful George was in a reflective mood as he thought about what he’d done with his life. REGRETFUL sorry Lee was always regretful that he had never travelled when he was younger. RELAXED taking it easy, calm, carefree On holiday, Pam felt happy and relaxed. RELIEVED freed from worry or anxiety At the restaurant, Ray was relieved to find he had not forgotten his wallet. RESENTFUL bitter, hostile The businessman felt very resentful towards his younger colleague who had been promoted above him. SARCASTIC cynical, mocking, scornful The comedian made a sarcastic comment when someone came into the theatre late. SATISFIED content, fulfilled Steve felt very satisfied after he had got his new flat just how he wanted it. SCEPTICAL doubtful, suspicious, mistrusting Patrick looked sceptical as someone read out his horoscope to him. SERIOUS solemn, grave The bank manager looked serious as he refused Nigel an overdraft. STERN severe, strict, firm The teacher looked very stern as he told the class off. SUSPICIOUS disbelieving, suspecting, doubting After Sam had lost his wallet for the second time at work, he grew suspicious of one of his colleagues. SYMPATHETIC kind, compassionate The nurse looked sympathetic as she told the patient the bad news. TENTATIVE hesitant, uncertain, cautious Andrew felt a bit tentative as he went into the room full of strangers. TERRIFIED alarmed, fearful The boy was terrified when he thought he saw a ghost. THOUGHTFUL thinking about something Phil looked thoughtful as he sat waiting for the girlfriend he was about to finish with. THREATENING menacing, intimidating The large, drunk man was acting in a very threatening way. UNEASY unsettled, apprehensive, troubled Karen felt slightly uneasy about accepting a lift from the man she had only met that day. UPSET agitated, worried, uneasy The man was very upset when his mother died. WORRIED anxious, fretful, troubled When her cat went missing, the girl was very worried.