Closed Captioning for Culturally Impaired: Theory of Mind and Executive Functions

Recently while having dinner with friends, the conversation moved to favorite TV shows. We each swapped names and nostalgically recited a few old shows including Seinfeld and Everybody Loves Raymond which are off the air now. Then my friend mentioned the show Family Guy shown during Adult Swim on Cartoon Network, which I do not care for. At this point my husband, who is not much into TV, let alone sitcoms, asked what adult swim was all about. The clinician that I am, I stepped in and gave this explanation-

“You know how swimming pools have a separate time for adults to swim during which kids are not allowed. Similarly, on Comedy Central they have a series of half-hour animated sitcoms that are meant for adults or rather, have adult content. Collectively they are called Adult Swim.” Listening to this explanation, my friend says, “Wow, you’re like an interpreter for the culturally impaired”! That was such a fascinating comment because it relates beautifully to what I do.

As part of my training I have learned many foundational principles related to language development, structure and use. The field of linguistics, which addresses Morphology, Syntax, Semantics and Pragmatics can be thought as dull and drab, but it speaks to me. Professionally, I deal a lot with Pragmatic disorders, which refer to one’s inability to use language to yield social connectivity or the inability to navigate through the social world using verbal and non-verbal communication.

A socially incompetent child or adult is like a gazelle in the savanna. Their more savvy or proficient peers act as lions and may pray on this gazelle. Unlike the animal world where the gazelle gets eaten, in human world, the gazelle may be subjected to neglect (being ignored or treated as an outcast) as much as being attacked (picked on) or they may simply get left out. The ability to influence the social world with use of language and non-verbal skills is one of the most striking feature of early child development and lays the foundation for developing friendships and becoming “likable”.

In a recent phone call with a mom of a 6th grade girl, I uncovered the social disorder I am describing here. The mom described her daughter’s inability to navigate through the middle school and not finding a fitting place amongst her 7th grade peers. The mom described a laundry list of observations or complaints that she felt were putting her daughter out of the social scene:

  • She is far more immature for her age than her friends
  • One time, she was bothered by a comments that her classmates made that she “meows like a cat”. Mom thinks that her daughter probably does do that but is unaware of it.
  • She loves dragons & fairies, gets carried away in pretend play for hours while her friends have moved on to Facebook and boys
  • Her best friend is one who is two years younger than her since their interests match
  • She bosses her best friend around and gets away with it because the other girl can’t really protest
  • She is messy and doesn’t think it’s important to present herself well. In the cafeteria you can see her eating awkwardly or sloppily
  • Academically, she does not study at all nor is she overly concerned about her grades but if she has true interest in the subject matter she will do very well
  • Since the beginning of the school year, she has started talking about being lonely and not having friends but she does not see how that goes hand in hand with what she’s doing

This type of phone call is very common in my practice. In essence, individuals with deficits in pragmatics and social cognition appear to be culturally impaired. They are somewhat behind their peers and they don’t fully grasp what they are not doing right or how it makes them stick out like a sore thumb. As you can imagine this may lead to social typecasting and eventually to social isolation. My role then is to become an interpreter of social-cultural barriers and translate them in a meaningful way.

Social cognition and social regulation hinges on executive functions, which are responsible for regulating behaviors and thinking. The critical EF concept behind development of social awareness and reciprocity lies in understanding a complex cognitive process.  Flavel & Miller proposed the concept of Theory Mind (TOM) which contends that people have intentions and they can act as agents to carry out their intentions. Theory of mind allows all of us to make sense of others’ actions, comments and behaviors, which we do by taking into consideration their mental as well as emotional states. Throughout the development, the notion of Theory of Mind undergoes metamorphosis allowing the individual to see others’ intentions as they become more and more veiled or invisible. These intentions get pursued via gestures, body language, tone of voice, eye-contact and implicit language messaging. If the observer or the communicator misses these subtleties then the social intent stays a mystery.

Throughout the course of treatment, I teach skills related to interpretation of actions, intent and social structure.

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at For any further communication, leave me a note here or contact me at

1 Comment

  1. Dianne Romero

    November 11, 2012 at 11:20 pm

    I would appreciate more information regarding your practice. Thank you

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