🎙️🔴 ASD Part 3 - The Gatekeeper That Should Not Exist

Neurolight Series — Part III
Theory of Mind, Performance, and the Illusion of Social Ease

asd3

Abstract

Theory of Mind (ToM) has long been treated as a diagnostic gatekeeper in autism assessment. Adults who demonstrate perspective-taking, empathy, or reflective social reasoning are frequently excluded from diagnosis on the assumption that autism entails a lack of ToM. This article argues that this assumption is scientifically outdated and clinically harmful. Drawing on contemporary research and lived experience, it shows how performance-based ToM assessments misread compensation, masking, ethics, and delayed processing as evidence of neurotypicality—resulting in systematic false negatives in adult autism diagnosis.

1. The Persistence of an Outdated Idea

The idea that autistic people lack Theory of Mind originated in early cognitive models of autism in the late 20th century. While influential, these models were never intended to function as absolute diagnostic rules.

Yet in adult clinical practice, Theory of Mind is still often used implicitly as a gatekeeper:

If you can understand others’ perspectives, you cannot be autistic.

This assumption persists despite decades of research showing that Theory of Mind is neither binary nor static.

2. Theory of Mind Is Not One Thing

Contemporary research demonstrates that Theory of Mind is:

  • multidimensional
  • developmentally variable
  • sensitive to learning, context, and motivation

Autistic adults may:

  • pass explicit ToM tasks
  • succeed in structured assessments
  • reason accurately about others’ perspectives

…while still experiencing:

  • social uncertainty
  • delayed emotional processing
  • exhaustion from constant reasoning
  • lack of intuitive social access

Passing a test does not equal living with ease.

3. Performance Is Not Process

Most Theory of Mind assessments measure outcome, not process.

They ask:

  • Can you infer what another person thinks?
  • Can you explain why someone acted a certain way?

They do not ask:

  • How long did that reasoning take?
  • What effort was required?
  • Was the response intuitive or constructed?
  • What happened in the body while answering?

Autistic adults often arrive at correct answers through:

  • conscious reasoning
  • ethical frameworks
  • learned social rules

This is not absence of autism.
It is evidence of compensation.

4. Compensation and the Adult Trap

By adulthood, many autistic people have:

  • studied social behavior
  • developed internal rule systems
  • learned scripts and heuristics
  • practiced restraint to avoid harm

Livingston & Happé (2017) describe this as compensation—strategies that allow individuals to achieve socially acceptable outcomes despite underlying difficulty.

Clinical systems, however, frequently misinterpret compensation as absence.

The better someone compensates, the less visible their autism becomes.

5. Ethics Misread as Empathy (Again)

A recurring diagnostic error occurs when ethical restraint is mistaken for intuitive empathy.

Responses such as:

  • giving someone space
  • not assuming emotional meaning
  • choosing non-intrusion

are often coded as evidence of intact emotional Theory of Mind.

In reality, these behaviors may arise from:

  • uncertainty about others’ internal states
  • moral caution
  • avoidance of harm

This is not emotional mirroring.
It is principled restraint.

6. The Cost of Passing

Passing Theory of Mind assessments comes at a cost that is rarely measured:

  • cognitive fatigue
  • emotional burnout
  • loss of spontaneity
  • chronic self-monitoring

Autistic adults may appear socially competent during short clinical encounters while paying for that performance later with shutdown, withdrawal, or physical illness.

Clinical snapshots do not capture this cost.

7. Childhood Evidence and the Myth of Absence

Adults are often excluded from diagnosis due to perceived lack of childhood evidence of Theory of Mind difficulties.

This ignores several realities:

  • early compensation may be invisible
  • trauma and punishment suppress expression
  • neurodivergent children often learn silence
  • records rarely capture internal experience

Absence of documentation is not absence of difficulty.

8. Theory of Mind as a Barrier to Care

When Theory of Mind is treated as a disqualifier:

  • autistic adults are denied diagnosis
  • access to support is blocked
  • individuals are discharged without follow-up
  • self-understanding is destabilized

The gatekeeper becomes a barrier—not a tool.

9. What Modern Assessment Must Do Instead

Ethical adult autism assessment must:

  • abandon Theory of Mind as an exclusion criterion
  • distinguish intuition from reasoning
  • assess effort and cost, not just correctness
  • allow time, narrative, and reflection
  • recognize compensation as evidence, not erasure

Theory of Mind should inform understanding—not decide belonging.

Conclusion

Theory of Mind was never meant to decide who is allowed to be autistic.

When psychiatry mistakes performance for ease, reasoning for intuition, and ethics for empathy, it excludes precisely those adults who have worked the hardest to survive.

The gatekeeper that should not exist continues to deny care—not because autism is absent, but because it is too well defended to be seen.

Listening must replace testing.

References

  • HappĂŠ, F. (1994). An advanced test of theory of mind.
  • HappĂŠ, F. (1995). The role of theory of mind in autism.
  • Senju, A. et al. (2009). Mindblind eyes: ToM and autism.
  • Livingston, L., & HappĂŠ, F. (2017). Conceptualising compensation in autism.
  • Livingston, L. et al. (2019). Compensatory strategies in autism.
  • NICE NG128 (2018). Autism spectrum disorder in adults.
  • American Psychiatric Association. DSM-5-TR (2022).
← Back