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Moderators of a Theory of Mind Intervention for Children with Autism Spectrum Disorder: A Randomized Controlled Trial

Saturday, 4 May 2013: 10:45
Meeting Room 3 (Kursaal Centre)
S. Begeer1,2, E. Hoddenbach1, P. Clifford3, C. Gevers3, C. Clauser4, F. Boer5 and H. M. Koot6, (1)Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands, (2)Developmental Psychology, University of Sydney, Sydney, Australia, (3)Wei43, Amsterdam, Netherlands, (4)Poli ASS, De Bascule, Duivendrecht, Netherlands, (5)De Bascule, University of Amsterdam, Amsterdam, Netherlands, (6)VU University, Amsterdam, Netherlands

Theory of Mind, the ability to attribute mental states to oneself or others, is a central domain of impairment among children with an Autism Spectrum Disorder (ASD). Many interventions focus on improving Theory of Mind skills in children with ASD. Nonetheless, the empirical evidence for the effect of these interventions is limited. Moreover, treatment outcomes appear to vary among children with ASD.


The main goal of this study was to examine the effectiveness of a short Theory of Mind intervention in a large group of children with ASD. A second objective was to determine whether the treatment outcome was moderated by social interaction style (Scheeren, Koot & Begeer, in press), and co-morbid problem behavior.


One hundred children with ASD and a normal IQ, aged 7 to 12 years, were randomly assigned to an intervention- or a waitlist control group. Outcome measures included a battery of Theory of Mind tasks (Muris et al., 1999) and emotion understanding tasks (LEAS-C, Bajgar et al., 2005), and parent- and teacher questionnaires on children’s social skills (SRS, Constantino & Gruber, 1997; SSQ, Spence et al., 2000). Follow up data for the intervention group were collected 6 months after the interventions.  Moderator variables included social interaction style, based on the Wing Subgroups Questionnaire (Castelloe & Dawson, 1993; Scheeren, et al.,  in press), and co-morbid problem, based on the Disruptive Behavior Disorders rating scale (Pelham et al., 1992).


Preliminary analyses on 80 of the 100 participants indicated positive effects of the intervention on the primary outcome measures. Children in the treatment group improved significantly compared to the waitlist control group in their performance on Theory of Mind and emotion understanding tasks. Moreover, parents and teachers reported enhanced social skills in children’s daily life functioning. The effects on social skills were moderated by social interaction style and co-morbid problem behavior. In particular, children with a passive social interaction style or higher levels of problem behavior showed lower treatment benefit.  


The current findings are promising with regard to the effectiveness and generalization of a short intervention focused on Theory of Mind skills. However, the moderator effects indicate systematic individual differences in treatment outcomes. A passive social interaction style and co-morbid problem behavior were shown to hamper the effect of the treatment. These findings highlight the need for treatments targeting specific social skills in specific groups of children with ASD.

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