Task Related Differences in the Theory of Mind Profile of School-Aged Children with ASD

Background:

Impairments in social functioning in autism spectrum disorder (ASD) are theoretically linked to an underlying deficit in theory of mind (ToM)–the social cognitive ability to take another’s perspective. Previous research has consistently documented ToM impairments in preschoolers with ASD (Baron-Cohen, Tager-Flusberg, & Cohen, 2000), but the investigations of ToM deficits in school-aged children with ASD and average IQ have produced mixed results (Scheeren et al., 2013).

Objectives:

To examine the pattern of individual differences in ToM in school-aged children with ASD and average IQ using a battery of ToM measures (e.g., precursors of ToM, first-order false belief, and second-order false belief). To compare ToM performance between children with ASD and typical development.

Methods:

To date, 41 children with ASD between the ages of 7-11 years have participated. All children had an ASD diagnosis (ADOS-2, ADI-R, DSM-5) and WASI-2 Full Scale IQ of 80 or higher. The ToM battery included tasks measuring: (1) precursors of ToM (TOM Test-Level 1 and Perception Knowledge task), (2) first-order false belief (Location Change False Belief task, Unexpected-Contexts False Belief task, and TOM Test-Level 2), and (3) second-order false belief (TOM Test-Level 3). The TOM Task (Muris et al., 1999) was presented on a laptop and all other measures were presented as videos with pre-recorded questions. We are currently collecting data from typically developing children (anticipated sample size of 30) and will compare the performance between groups. We are also collecting data from additional children with ASD (anticipated final sample size of 65).

Results:

ToM precursors were not significantly related. Instead, age related improvements were detected on Perception Knowledge, r(41) = .34, p = .03, whereas TOM-Level 1 related to language level, r(29) = .44, p = .02. Performance across first-order false belief tasks were related, Chronbach’s a=.65; rs > 0.36, ps < .03. Within these measures, Location Change False Belief improved with age, r(40) = .37, p = .02, and TOM-Level 2 performance was associated with language ability, r(29) = .40, p = .03. Finally, the second-order false belief measure, TOM-Level 3, was sensitive to both age, r(40) = .42, p = .01, and language level, r(29) = .50, p = .01. Across all measures, nonverbal IQ was not related ToM. Finally, ADOS-2 severity scores were examined with respect to ToM. More severe symptoms related to worse performance only on the Unexpected Contents Task, r(36) = -.40, p = .02.

Conclusions:

Overall, our research has important implications for understanding the heterogeneity in social functioning and social cognition in school-aged children with ASD. First, variables within a ToM level were only moderately related at best. Second, some tasks in our battery measuring multiple levels of ToM continue to detect developmental changes in ASD–even among school-aged children without cognitive impairment (i.e., Perception Knowledge, Location Change, and TOM-Level 3). As with previous work (Steele, Joseph, & Tager-Flusberg, 2003), language level influenced performance, especially for the TOM Task. Finally, ToM performance was generally not related to ASD symptoms in this age range.