In your own words describe Theory of Mind (TOM) and how it develops for typically developing children.? 2.Explain what you understand about the controversy surroundin

SPECIAL SECTION: HETERODOX ISSUES IN PSYCHOLOGY

Empirical Failures of the Claim That Autistic People Lack a Theory of Mind

Morton Ann Gernsbacher University of Wisconsin—Madison

Melanie Yergeau University of Michigan

BA BA A B S T R A C T

The claim that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. This article (a) reviews empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks; (b) highlights original findings that have failed to replicate; (c) documents multiple instances in which the various theory-of-mind tasks fail to relate to each other and fail to account for autistic traits, social interaction, and empathy; (c) summarizes a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric; and (d) concludes that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

S C I E N T I F I C A B S T R A C T

The assertion that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. In this article, we critically examine the empirical basis of this assertion. We review empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks. We highlight seminal theory- of-mind findings that have failed to replicate. We document multiple instances in which the various theory-of-mind tasks fail to converge and fail to predict autistic traits, social interaction, and empathy. We summarize a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by

This article was published December 9, 2019. Morton Ann Gernsbacher, Department of Psychology, University of Wisconsin—Madison; Melanie Yergeau, Department of English Language and Literature,

University of Michigan. This article is part of the special section “Heterodox Issues in Psychology.” The guest editor for this section is Scott O. Lilienfeld. The authors have made available for use by others the data that underlie the analyses presented in this article (see Gernsbacher, 2018a), thus allowing replication

and potential extensions of this work by qualified researchers. Next users are obligated to involve the data originators in their publication plans, if the originators so desire.

The data are available at https://doi.org/10.17605/OSF.IO/3R2QY The experiment materials are available at https://doi.org/10.17605/OSF.IO/3R2QY

This article has been published under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Copyright for this article is retained by the author(s). Author(s) grant(s) the American Psychological Association the exclusive right to publish the article and identify itself as the original publisher.

Correspondence concerning this article should be addressed to Morton Ann Gernsbacher, Department of Psychology, University of Wisconsin—Madison, 1202 West Johnson Street, Madison, WI 53706. E-mail: [email protected]

Archives of Scientific Psychology 2019, 7, 102–118 © 2019 The Author(s) DOI: http://dx.doi.org/10.1037/arc0000067 2169-3269

Archives of Scientific Psychology

www.apa.org/pubs/journals/arc

researchers working inside the theory-of-mind rubric. We conclude that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

Keywords: autism, theory of mind, convergent validity, predictive validity, reproducibility Data repository: http://dx.doi.org/10.17605/OSF.IO/3R2QY

Most of us have a theory of mind in that we can guess what others are thinking and how that might differ from what we are thinking. Those with autism can be thought of as mindblind in that they cannot imagine what others might be thinking, or even that others are thinking. . . . To them, it would be like looking at the headlights of a car to determine why the car just did what it did, or what information it is trying to convey to us.

—The Encyclopedia of Neuropsychological Disorders (Soper & Murray, 2012, p. 125)

The assertion that autistic1 people lack a theory of mind—that they fail to understand that other people have a mind or that they them- selves have a mind—pervades psychology. The assertion is taught across a wide range of psychology textbooks (Coon, Mitterer, & Martini, 2018; Kellogg, 2007; Kirk, Gallagher, Coleman, & Anasta- siow, 2008; Mash & Wolfe, 2015; Myers, 2009, 2012; Sigelman & Rider, 2017). The assertion is argued by psychologists in state and federal court cases (Carter v. Superintendent, 2011; New Jersey v. Burr, 2007; United States v. Geanakos, 2017). The assertion is pro- moted by thousands of psychology articles; in fact, the vast majority— over 75%—of the top 500 articles indexed by Google Scholar (for “theory of mind” and “autism”) simply assert that autistic people lack a theory of mind rather than provide original data to buttress the claim (too do children with specific language impairment (Gernsbacher, 2018a).2

Clearly, the assertion that autistic people lack a theory of mind has become one of psychology’s sacred cows, a critical evaluation of which the current special issue solicited.

In this article, we review empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks. We highlight seminal theory-of-mind findings that have failed to replicate. We document multiple instances in which various theory-of-mind tasks fail to converge and fail to predict autistic traits, social interac- tion, and empathy. We summarize a large body of data, collected by researchers working outside the theory-of-mind rubric, that fail to support assertions made by researchers working inside the theory-of- mind rubric. We conclude that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

Failures of Specificity

For nearly two decades, Simon Baron-Cohen and his colleagues claimed that poor performance on theory-of-mind tasks uniquely characterized autistic people (see Table 1).The initial claim was staked on autistic children’s performance on a theory-of-mind task called False Belief. In a False Belief task, a child might be introduced to two puppets, one named Sally and the other Anne. The child watches as the Sally puppet places a possession, such as a marble, inside a basket. Then, the Sally puppet is taken away, and the Anne puppet moves the marble from its previous location to another loca- tion, such as inside a box. When the Sally puppet is represented, the child is asked orally, “Where will Sally look for her marble?” If the child answers with the location where the marble actually is, rather than the location where the first puppet placed the marble, the child is considered to have failed the False Belief task and to lack a theory of mind.

Other tasks have been used to assess theory of mind; some of the more popular ones appear in Table 2. But it was autistic children’s performance on False Belief tasks that propelled Baron-Cohen and his colleagues’ claim that autistic people uniquely lack a theory of mind.

However, autistic children are not unique in failing False Belief tasks; so too do children with specific language impairment (Loukusa, Mäkinen, Kuusikko-Gauffin, Ebeling, & Moilanen, 2014; Norbury, 2005); Down syndrome (Zelazo, Burack, Benedetto, & Frye, 1996); Williams syndrome (van Herwegen, Dimitriou, & Rundblad, 2013); Prader Willi syndrome (Lo, Siemensma, Collin, & Hokken-Koelega, 2013); cerebral palsy (Caillies, Hody, & Calmus, 2012; Dahlgren, Dahlgren Sandberg, & Hjelmquist, 2003); Fragile X (Cornish et al., 2005); epilepsy (Raud, Kaldoja, & Kolk, 2015); and neurofibromato- sis type I (Payne, Porter, Pride, & North, 2016), as well as children exposed prenatally to maternal smoking (Reidy, Ross, & Hunter, 2013) and drinking (Rasmussen, Wyper, & Talwar, 2009). Indeed, the more atypical the child, the more likely they are to fail false belief tasks.

Even typically developing children with fewer rather than more siblings (Jenkins & Astington, 1996; Peterson, 2000), with lower rather than higher socioeconomic status (Hughes & Ensor, 2005), or with fewer rather than more adult relatives living nearby (Lewis, Freeman, Kyriakidou, Maridaki-Kassotaki, & Berridge, 1996) are more likely to fail False Belief tasks, as are children who are blind (Brambring & Asbrock, 2010; Green, Pring, & Swettenham, 2004; Minter, Hobson, & Bishop, 1998; Peterson, Peterson, & Webb, 2000) or deaf/hard of hearing (Figueras-Costa & Harris, 2001; Jackson, 2001; Lundy, 2002; Meristo et al., 2007; Moeller & Schick, 2006; Peterson & Siegal, 1995; Russell et al., 1998).

More recently, Baron-Cohen has acknowledged that a lack of theory of mind “may not be specific” to autistic people (Baron-Cohen, 2009, p. 70; 2010, p. 169). For nearly 30 years, other researchers have also tried to correct this inaccurate claim (Eisenmajer & Prior, 1991; Frye, Zelazo, & Burack, 1998; Prior, Dahlstrom, & Squires, 1990; Tager-Flusberg, 2001, 2007; Yirmiya & Shulman, 1996; Yirmiya, Erel, Shaked, & Solomonica-Levi, 1998; Zelazo, Jacques, Burack, & Frye, 2002). But the erroneous claim that only autistic people, “to- gether with robots and chimpanzees” lack a theory of mind (Pinker, 2002, p. 62; see also Mitchell, 1997) and are therefore “biologically set apart from the rest of humanity in lacking the basic machinery” (Baron-Cohen, 2009, p. 73) echoes throughout psychological litera- ture, practice, and instruction (cf. Gernsbacher, 2007; Yergeau, 2013; Yergeau & Huebner, 2017).

1 We use identity-first language (e.g., autistic people, nonautistic people) rather than person-first language (e.g., people with autism, people without autism) because identity-first language is preferred by autistic people (Kenny et al., 2016), is recommended by APA (Dunn & Andrews, 2015), and is less likely to contribute to stigma (Gernsbacher, 2017).

2 All materials and data supporting the conclusions drawn in this article are available in Gernsbacher (2018a), which is a technical report available on the Open Science Framework.

103EMPIRICAL FAILURES OF THEORY OF MIND CLAIMS

Failures of Universality

A lack of a theory of mind is often assumed to be not only a unique characteristic of autistic people, but also a universal characteristic of all autistic people. Repeatedly, Baron-Cohen has claimed that “mind- blindness . . . is universal in applying to all individuals on the autistic spectrum” (Baron-Cohen, 2008a, p. 61; Baron-Cohen, 2008b, p. 113; Baron-Cohen, 2009, p. 70; Baron-Cohen, 2010, p. 169; Baron-Cohen, 2011a, p. 40; Baron-Cohen, 2011b, p. 629; see also Table 3). This assumed universality has been widely promoted across psychology, as the opening quote of our article illustrates. However, as other authors note, many autistic children and adults pass theory-of-mind tasks; therefore, these other authors rightly argue that “mindblindness” can- not be a universal characteristic of autism (e.g., Bailey, Phillips, & Rutter, 1996; Bauminger & Kasari, 1999; Beversdorf et al., 1998; Boucher, 2012; Buitelaar, van der Wees, Swaab-Barneveld, & van der Gaag, 1999b; Charman, 2000; Ozonoff, Rogers, & Pennington, 1991).

Why do some autistic participants pass theory-of-mind tasks while others do not? Numerous researchers have aptly noted that theory-of- mind tasks rely heavily on spoken language (see Gernsbacher & Frymiare, 2005, and Gernsbacher & Pripas-Kapit, 2012, for reviews). For example, nearly half the variance in participants’ performance on

False Belief tasks can be predicted by their spoken language compre- hension (Capage & Watson, 2001); nearly three fourths can be pre- dicted by their facility with vocabulary (Steele, Joseph, & Tager- Flusberg, 2003) and appreciation of grammar (Peterson, Wellman, & Slaughter, 2012). In longitudinal studies, vocabulary predicts False Belief performance more powerfully than age (Steele et al., 2003); in studies comparing autistic to nonautistic participants, vocabulary pre- dicts False Belief performance more powerfully than whether the participants are autistic (Loukusa et al., 2014; Norbury, 2005; see also Milligan, Astington, & Dack’s, 2007, meta-analysis with over 100 studies of typically developing children; Yirmiya, Erel, Shaked, and Solomonica-Levi [1998], meta-analysis with 40 studies of autistic children; and Gernsbacher, 2018a, for studies published after these meta-analyses).

Other theory-of-mind tasks also draw heavily on spoken language. Happé’s (1994a) Strange Stories task (see Table 2) requires compre- hending complex stories and answering complex questions, which is why complex language comprehension can be the task’s “only” pre- dictor (Shaked, Gamliel, & Yirmiya, 2006, p. 183), and vocabulary can account for more than three fourths of the variance (de Lima Velloso, Duarte, & Schwartzman, 2013; see also Abell & Hare, 2005;

Table 1 Researchers’ Claims That Lack of Theory of Mind Is Specific to Autism

Citation Quotation

Baron-Cohen (1988, p. 393) “autistic children of normal intelligence failed to demonstrate that they could distinguish their own belief from someone else’s (Baron-Cohen, Leslie, & Frith, 1985, 1986). This is seen as an autism-specific deficit.”

Baron-Cohen (1989a, p. 188) “What they seem to have specific difficulty with is understanding and predicting behavior in situations in which covert mental state attributions are required (Baron-Cohen, 1989a, 1989b, in press; Baron-Cohen et al., 1985, 1986; Leslie & Frith, 1988)”

Baron-Cohen (1989b, p. 294) “The search for why a theory of mind fails to develop or is severely delayed in autism remains a key question for future research, and raises the clinical issue of whether any intervention could reduce this specific delay.”

Baron-Cohen (1989c, p. 200) “the theory of mind hypothesis never set out to explain repetitive behaviours or phenomena other than the autism-specific, communicative and imaginative impairments”

Baron-Cohen (1990, pp. 81, 84) “There is indeed an autism-specific cognitive deficit in this domain”; “The data from the control groups further reveals that such a deficit must be autism-specific, rather than the result of general developmental delay”

Baron-Cohen (1991a, p. 249) “The general assumption in the specific developmental delay theory is that autistic children’s physical- causal knowledge is mental age appropriate and the only delayed aspect of their development that is specific to autism is in their theory of mind.”

Baron-Cohen (1991b, pp. 35, 47) “the theory of mind deficit appears to be highly specific”; “they seem to have a specific inability to understand the ‘representational mind’”

Baron-Cohen (1991c, p. 312) “the present results are therefore consistent with the hypothesis that the deficit in the development of a theory of mind in autism is highly specific”

Baron-Cohen (2000b, p. 15) “children [with other developmental disabilities] may also have equivalent difficulty on ‘control’ tasks such as the False Photograph Task . . . whilst children with autism may show a specific deficit only on the theory of mind task”

Baron-Cohen (2001, p. 179) “children [with other developmental disabilities] may also have equivalent difficulty on ‘control’ tasks such as the False Photograph Task . . . while children with autism may show a specific deficit only on the theory of mind task”

Baron-Cohen and Swettenham (1997, p. 883) “We can therefore interpret these results in terms of there being a specific developmental delay in theory of mind at a number of different points.”

Baron-Cohen, Campbell, Karmiloff-Smith, Grant, and Walker (1995, p. 392)

“Results from both conditions thus provided converging evidence for an autism specific deficit in inferring when a person is thinking”

Baron-Cohen et al. (1985, pp. 37, 44) “Thus the dysfunction we have postulated and demonstrated is . . . specific to autism”; “We conclude that the failure shown by the autistic children in our experiment constitutes a specific deficit”

Baron-Cohen, Leslie, and Frith (1986, p. 121) “These results confirm and extend the findings of Baron-Cohen et al. (1985) that autistic children show a specific deficit in employing a ‘theory of mind’”

Baron-Cohen, Ring, Moriarty, Schmitz, Costa, and Ell (1994, p. 642)

“This deficit is further evidence for an autism-specific impairment in the child’s concept of mind”

Frith and Happé (1994, p. 126) “At present, all the evidence suggests that we should retain the idea of a modular and specific mentalizing deficit in our causal explanation of the triad of impairments in autism.”

Leslie and Thaiss (1992, p. 226) “We argue that children are equipped with a domain-specific processing mechanism (“ToMM”) which allows the child to attend to mental states, which . . . is specifically impaired in autism.”

Note. ToMM � theory of mind mechanism.

104 GERNSBACHER AND YERGEAU

Botting & Conti-Ramsden, 2008; Dyck, Ferguson, & Shochet, 2001; Frölander et al., 2014; Kaland et al., 2005; Loth, Gómez, & Happé, 2008; Scheeren, de Rosnay, Koot, & Begeer, 2013; Solomon, Goodlin-Jones, & Anders, 2004).

Even performance on Baron-Cohen, Wheelwright, Hill, Raste, and Plumb’s (2001) Reading-the-Mind-in-the-Eyes task “involves sophis- ticated vocabulary” (Muller et al., 2010, p. 1095), which is why the best predictor of Reading-the-Mind-in-the-Eyes can be Speaking- Aloud-Hard-to-Pronounce-Words (Lawrence, Shaw, Baker, Baron- Cohen, & David, 2004) and why vocabulary and grammar can ac- count for nearly half the variance (Bennett et al., 2013; see also Botting & Conti-Ramsden, 2008; Castelli et al., 2011; Dorris, Espie, Knott, & Salt, 2004; Olderbak et al., 2015; Pino et al., 2017; Peterson & Miller, 2012).

Because theory-of-mind tasks rely heavily on “fairly complex lan- guage” (San José Cáceres, Keren, Booth, & Happé, 2014, p. 608) and because autism, by diagnostic definition, involves communication impairment (Gernsbacher, Morson, & Grace, 2016), it is unsurprising that autistic participants with communication impairment perform less well than nonautistic participants without communication impairment. And because autistic people vary in their communication impairment (Gernsbacher, Geye, & Ellis Weismer, 2005), it is unsurprising that autistic people vary in their theory-of-mind task performance.

The heavy reliance of theory-of-mind tasks on language has led theory-of-mind proponents to claim that autistic people who pass theory-of-mind tasks must be using their linguistic abilities to “hack out” the answers (Happé, 1995, p. 853; Tager-Flusberg, 2001, p. 185). This claim might seem superficially sound, but it is hard to reconcile with the fact that autistic people, on average, have communication impairments. How and why would autistic people preferentially use language to “hack out” the answers while nonautistic people, without communication impairments, do not? A related claim made by those who assume that all autistic people must lack a theory of mind, is that autistic people who pass theory-of-mind tasks must use some un- known “logic” or post hoc “strategy” (Baron-Cohen, 2006, p. 868; Frith, Happé, & Siddons, 1994, p. 110; Happé, 1994a, p. 130, 1994b, p. 220). But such post hoc claims seem to fail their own test of logic.3

Failures of Replication

Reproducibility is the cornerstone of science, as psychology’s cur- rent focus on replication illustrates (Gernsbacher, 2018b, 2018c, 2018d; Spellman, 2015; Tackett et al., 2017). However, when tests of reproducibility are applied to claims about autism and theory of mind, the seminal findings frequently fail.

For example, cognizant of the heavy reliance on language by most theory-of-mind tasks, Baron-Cohen, Leslie, and Frith (1986) designed a nonverbal task. Children were given a scrambled set of four pictures and told to arrange the pictures in a coherent order. One set of pictures displayed a boy standing at the top of a hill with a basketball-sized rock next to his foot; another picture displayed the boy with his foot close to the rock, as though ready to kick it; another picture displayed the rock halfway down the hill; and another picture displayed the rock at the bottom of the hill. Baron-Cohen et al. (1986) deemed this type of picture sequence “mechanical,” and autistic children were almost perfect in sequencing such pictures. Oddly, typically developing chil- dren performed below 50% correct on these “mechanical” pictures— which most likely was unexpected because Baron-Cohen et al. (1986, p. 116) deemed these “mechanical” pictures “the simplest.”

Another set of pictures displayed a boy sitting on the ground holding an ice cream cone to his mouth with a girl standing nearby; in another picture, the ice-cream-holding boy is looking at the girl who, in this picture, is also sitting on the ground; in another, the girl is reaching for the boy’s ice cream cone while he stretches his arm as far as possible away from the girl’s reach; in the final picture, the girl holds the ice cream cone to her mouth, while the boy rubs his eyes. Autistic and typically developing children were equally adept at arranging this type of picture sequence, which Baron-Cohen et al. (1986, p. 115) deemed “behavioral” and, quite curiously, not an assay

3 For example, some researchers claim that autistic children “fail the false belief task because they lack the capacity to acquire a theory of mind,” whereas nonautistic children “fail the false belief task because of general task demands, because they don’t have a grasp of false belief, or both. But they surely have a ‘theory of mind’” (Bloom & German, 2000, p. B29).

Table 2 Examples of Popular Theory-of-Mind Tasks

Type of task Example

False Belief task (first-order) Participant is shown a container with which they’d be familiar, for example, a closed bag of M&M candies. Participant is asked to predict what’s inside. The bag is opened, and the participant is shown that their belief about the contents was false: The bag doesn’t contain M&M candies; instead, it contains erasers. Participant is asked “What did you think would be inside the bag before I opened it?” If participant answers with the name of the bag’s actual content (e.g., erasers) rather than the name of the bag’s expected content (e.g., candy), the participant fails the false belief task.

False Belief task (second-order) Similar to a first-order False Belief task (as illustrated above), except that the participant is asked, “What do you think another person would think would be inside the box before I opened it?”

Strange Stories task Participant listens to a spoken story that contains a spoken deception (e.g., a lie, white lie, pretense, or double-bluff), a figure of speech (e.g., a metaphor or irony), a misunderstanding, persuasion, or the like. Participant is required to orally explain why the person said what they said and what they were thinking when they said it.

Faux Pas task Participant listens to a spoken story that contains a social interaction, such as a person showing newly bought curtains to a friend, who says they don’t like the curtains. Participant is required to identify whether “someone said something that they shouldn’t have” and, if so, to orally explain why the person said something that they shouldn’t have, what they should have said instead, and what the person and their friend must have been thinking when the person said what they said.

Animated Triangles task Participant views a series of animations with geometric triangles. After each animation, the participant is asked to orally explain “What happened in the animation?” Unknown to the participant, their oral answers are scored according to how likely they are to interpret the animated triangles as humans interacting and the number of emotional terms they provide in their oral explanation (e.g., if they say that one triangle was bullying another triangle).

Reading-the-Mind-in-the-Eye task

Participant views only the eye region of numerous black and white photographs and for each photograph is required to select one emotional expression from a set of four emotion terms (e.g., terrified, upset, annoyed, or arrogant).

105EMPIRICAL FAILURES OF THEORY OF MIND CLAIMS

of the characters’ intentions or requiring an understanding of “mental states.”

An example of the last type of picture sequence displayed a girl holding a teddy bear in her arms, while a flower extends from the ground beside her; in another picture, the girl is turned completely to one side and is holding the flower’s stem, while the teddy bear is on the ground behind her; in another, the girl is holding the flower to her nose, while a boy, standing behind the girl, reaches for the teddy bear on the ground; in the final picture, the girl is turned around, there’s no boy or teddy bear, and the girl’s mouth is wide open. Baron-Cohen et al. (1986, p. 116, 224) deemed this picture sequence “intentional,” and the typically developing children, who performed so shockingly poorly on the “simplest” mechanical pictures performed nearly per- fectly on these pictures, whereas the autistic children performed poorly. Baron-Cohen et al. (1986, p. 113) used these data to claim that “a specific cognitive deficit . . . prevents the development of a ‘theory of mind’ in the autistic child.”

Four research teams, of whom we are aware, have published attempts to directly replicate these results—and none could do so. Using the same stimuli, procedures, and analyses, no other research team has replicated the finding that autistic participants perform significantly worse than typically developing participants on the “in- tentional” picture sequences (“there were no group differences on the

intentional subtest of the picture sequencing measure,” Ozonoff, Pen- nington, & Rogers, 1991, p. 1093; “contrary to . . . previous findings (Baron-Cohen et al., 1985, 1986), [the intentional condition of the Picture Sequence Task] . . . failed to reveal significant differences,” Oswald & Ollendick, 1989, p. 122; “no two groups were significantly different [on the Intentional picture sequence],” Buitelaar, van der Wees, Swaab-Barneveld, & van der Gaag, 1999a, p. 46; “The [autis- tic] participants were close to ceiling . . . on the intentional Picture Sequencing items,” Brent, Rios, Happé, & Charman, 2004, p. 286).

Not only does Baron-Cohen et al.’s (1986) seminal theory-of-mind study fail to replicate, but its initially reported effect size, d � �1.714, looms unusually large (Ioannidis, 2008). In contrast, its replications’ pooled effect size is normatively tiny, d � �0.039 (Gernsbacher, 2018a), with a confidence interval (CI) that easily overlaps zero (i.e., 99.9% CI [�0.690, 0.611], giving us 99.9% confidence that the true effect includes zero). We are also unaware of any published studies that have replicated Baron-Cohen et al.’s (1986, pp. 116, 224) report that typically developing participants are dramat- ically worse on the “simplest&

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