Theory of Mind training in children with autism: preliminary results of a large scale, randomized controlled trial

Background:

Poor empathy or ‘Theory of Mind’ is a central feature of autism spectrum disorders (ASS). Treatments of children with ASS often involve attempts to train their Theory of Mind skills. However, international research on Theory of Mind training in children with ASS is hampered by small samples, absence of randomized control trials, poorly designed outcome measures.

Objectives:

We aim to study the treatment effect of a Theory of Mind training in children with ASS aged 8 to 12 years old in a large scale randomized cross-over clinical trial with measures of conceptual and practical skills and background factors.

Methods:

The Theory of Mind training is provided group wise to 5 or 6 children simultaneously, in 16 weekly 60 min sessions. 100 children with ASS will be assigned to training or waiting list conditions, in two cohorts of 50 children with ASS each. Both cohorts will be measured three times with intervals of about four months. The first group receives the Theory of Mind training during the first interval, and no intervention during the second interval. The second group receives the training during the second interval, and will be on a waiting list during the first interval.

Results:

The preliminary results of the study show evidence for improvement in the conceptual Theory of Mind skills, but little evidence for increased practical skills. Age and symptom severity had little impact, but intelligence increased treatment effect on conceptual skills.

Conclusions:

The effects of the Theory of Mind training seem confined to conceptual skills. However, children with ASS and normal IQs are generally less impaired on conceptual levels. This raises the question about how interventions should be designed in order to improve practical Theory of Mind skills.