Brief Report: Developmental Change in Theory of Mind Abilities in Children with Autism.

Steele S, Joseph RM, Tager-Flusberg H.

Journal of Autism and Developmental Disorders. August 2003; 33(4): 461-467.

Bottom Line

Can language skills predict theory of mind ability?

  • Children and adolescents with autism have difficulty engaging in day-to-day interactions with others.
  • This study showed that the better the child’s vocabulary, the better the child got at “mind reading” or theory of mind tasks as he/she grew older.
  • It is potentially very important that training be done in both theory of mind skills (such as being able to understand the difference between a lie and a joke, to detect sarcasm, or to understand other people’s motivation) and language skills.
  • This study showed that there is improvement in these skills as the child develops and that training may help the child to better function in the everyday world.

Question: Do theory of mind abilities change according to a child's developmental stage?

Background: Theory of mind refers to a person's abilities to comprehend that others have their own thoughts and feelings and to imagine what others are thinking, based on a shared understanding of an event or situation. Theory of mind also refers to the ability to distinguish between lies and jokes and to understand how people's personal traits influence their intentions (e.g., not everybody is kind and wishes one well). This study looked at whether theory of mind abilities change over one year and if they are influenced by language development or by I.Q.

Design: Time series.

Setting: The participants were seen at the Eunice Kennedy Shriver Centre in Massachusetts, USA.

Participants: The participants were 57 children between the ages of 4 and 14 who are taking part in an ongoing study of language in autism. All had had their diagnosis of autism confirmed with the ADI-R and the ADOS.

Assessment of prognostic factors: The Peabody Picture Vocabulary Test (PPVT) and the Expressive Vocabulary Test (EVT) were used to evaluate language functioning. I.Q. was tested using the Differential Abilities Scales (DAS). Both tests were applied at Time 1 (initial visit for this study) and at Time 2 (one year after the initial visit).

Method: The blood test results of children with autism who were on the gluten-free, casein-free diet were compared to those of children with autism who received an unrestricted diet. The blood test results of children with autism who were on a regular diet were compared to age- and sex-matched controls who had developmental delay but no autism to see if there were patterns of amino acid deficiency that were specific to autism.

Main Outcome Measures: Researchers reviewed the results of a battery of theory of mind tests that elicit a child's knowledge of what other people know, whether they can distinguish between lies and jokes or sarcasm, and how well they understand personal traits (such as being "kind" or being "mean") and how these traits influence a person's intentions and actions.

Main Results: The authors found that the children with autism showed changes in theory of mind abilities over a one year period, with more than half of the children gaining some understanding of mental states during the course of the study. The level of a child's vocabulary at baseline tended to predict increases in theory of mind scores.

Conclusions: This study highlights the potential importance of training in both language and theory of mind skills as means of promoting social communication abilities in young children with autism. The authors also state that social communication training should be undertaken in children with autism with the expectation that they will eventually show progress as they proceed through their developmental stages and that the training may enhance their ability to function in the everyday world.