Theory of Mind, Friendship and Social Status in Children with Autism Spectrum Disorders

Background: In children with Autism Spectrum Disorder (ASD), the difficulties in social interactions contribute greatly to hinder the establishment of friendship. However, in our day care units, we observed these children have interpersonal experiences that can sometimes lead them to real peer relationships. Like all children, they get a lot of satisfaction and developmental benefits of these friendships. But we also notice that some of them seem more popular or more attractive than others. Data from the international literature and daily observation of children with ASD in group suggest that the level of access to the theory of mind ToM) and the type of diagnosis are important factors. A better understanding of factors involved in the development of friendships among children with ASD may allow us to better support these relationships through our therapeutic interventions.

Objectives: To explore, in a group of children with ASD, whether there is a link between the status in the peer group and the following parameters: theory of mind and diagnosis. To propose to use these data in a therapeutic perspective: assessment and social skills training.

Methods: 28 children, aged 8 to 12 years treated in our day care unit participated in our preliminary study, for two consecutive school years. They were divided into 2 groups according to DSM-IV criteria: 14 had autistic disorder (299.00) and 14 had PDDnos (299.80)]. The status of each child in the group (popular, rejected, neglected or controversial) was determined from questionnaire developed by  J.D Coie, K.A Dodge et H.Copotelli : Children  named the three preferred and the three less appreciated children; educators gave their evaluation of  peer relationships between children. The sociometric methods defined by J.C Perry allowed to determine a score of social preference and impact. The presence of ToM was measured by test scores at Smarties  and Sally-Anne test. The data were processed using the software STATVIEW (SAS Institute, USA), Chi 2 test and when it was required, by Fisher exact test.

Results: There is a statistically significant correlation: Between sociometric status and presence of theory of mind: 2/3 of children with "popular" status in the group acquired theory of mind and 90% of children with the "rejected" status have not acquired theory of mind;Between sociometric status and diagnostics. : 2/3 of children with PDDnos have a popular status, 80% of children with autistic disorders are rejected or neglected.

Conclusions: In our care unit, children with ASD discover and learn social skills, supported by cognitive workshops and educational interventions. Our results supplemented by data from the international literature can consider a number of avenues to support friendship among children with ASD:To enhance the work on theory of mind in social skills training groups; to use data from sociometry to assess, in ecological environment, the impact on social skills training strategies. Moreover, such an exploration, better identifying the most vulnerable children, can prevent the phenomenon of bullying.