Welcome to the January edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this,  Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to [email protected].


Q: I need help! I have a 21-year-old grandson whom I raised from age 1 – 12 yrs. Since then he moved in with his mother. He was always quiet, but quite smart however he has grown more isolated over the years. He doesn’t have any friends or social interactions. He is in college – grades are decent but no interaction with fellow students. He has a job, but no interaction with coworkers. I think he may have autism. I can’t get him to see a psychologist. What can I do? We live in Missouri.

A: I hear where you’re coming from. It’s hard to watch a loved one appear to struggle. It’s not uncommon for the social networks of adults with autism to dwindle after their schooling ends; it makes sense that when the social support offered in the school setting disappears, so does that social network. However, it’s worth thinking about the measuring stick with which we measure social success. It sounds to me like your grandson is engaged in higher education, holds a job, and lives fairly independently. While we, ourselves, may not be able to imagine not having more of a social network, your grandson may find it perfectly satisfying to see fellow students at school, see co-workers at work, and then head home to recharge and do his own thing. In sum, it comes down to the level of satisfaction your grandson feels with his social network. He may not see it as lacking at all, which explains why he is not seeking help.


 Q: Your blog entry about Theory of Mind (ToM) was the first article I have read about that topic. I found it was an interesting way of explaining something that is so abstract and hard to explain. Your article got me thinking about what we call “normal” and “abnormal.” For example, is it possible that children with ASD have more advanced ToM? Maybe they have the answers we’re looking for? Has there been research done about this?

A: Thank you for following our blog and thank you for writing in. In fact, there has been a great deal of research regarding Theory of Mind (ToM) and autism spectrum disorder (ASD). We know from the research that individuals with ASD often demonstrate less developed ToM than their “typically developing” counterparts.

Less-developed ToM may be what is behind many of the criteria we use to diagnose ASD.  For example, ToM limitations manifest as things like difficulty taking the perspective of others, difficulty reading emotions or facial expressions of others, and difficulty with reciprocity (like in a back-and-forth of conversations). It makes sense, right? If you have a hard time predicting your conversational partner’s thoughts or emotions, it will be hard to know if they are enthralled or bored with your detailed description of how black holes work. For more information, you might look into some of Michelle Garcia-Winner’s work regarding ToM.