Young Children’s Understanding of Desires and Beliefs: Effects of Autism Spectrum Disorder and Modality on Theory-of-Mind

Background:  Theory-of-mind (ToM) abilities reflect a capacity to understand and react to thoughts and emotions in oneself and in others. Around age three years, many typically-developing (TD) children are able to reason about their own and others’ mental states, particularly desires and beliefs. In contrast, children with autism spectrum disorder (ASD) and non-ASD developmental delays (DD) often show significant delays in mastering ToM skills (Baron-Cohen, Leslie, & Firth, 1985). However, there has been little research on the emergence of understanding desires and beliefs, the influence of modality on ToM performance, and the relationship of parent’s perceptions of their child’s ToM skills to ToM task-performance.

Objectives:  We investigated 1) whether ASD and DD affect ToM performance in the auditory modality and the visual modality, and 2) whether parent’s perceptions of their child’s ToM abilities correspond with their child’s performance on desire and belief tasks.

Methods:  42 three-year-old children (17 female) and parents were recruited for a larger project documenting the early development of communication and social understanding. There were three groups: ASD (n=13), DD (n=14), and TD (n=15) children. All children received four ToM tasks: two visual items adopted from Wellman and Liu’s (2004) ToM scale assessing diverse desires and diverse beliefs and two newly-crafted auditory items also assessing desire- and belief-understanding. Parents completed the Theory of Mind Inventory (ToMI; Hutchins, Prelock, & Bouyea, 2014) from which we selected 6 items that focused on desires and beliefs. For each item, parents used a Likert scale ranging from 0 to 20 to indicate their child’s ToM-understanding.

Results:  Children with ASD (M=0.31, SD=.48) and with DD (M=0.50, SD=.76) passed significantly fewer ToM items than TD children (M=2.60, SD=1.06), F(2,41)=35.13, p<.001. The ASD and DD means did not differ significantly nor was there a significant effect of modality or a significant modality x group interaction. There was a significant association between group and the number of children who did not pass any ToM tasks, χ2(2, N=42)=17.57, p<.001. We found a significant difference in the average ToMI score by group, F(2,41)=5.62, p<.007, with no significant difference between parents of children with ASD (M=6.33, SD=4.94) or DD (M=7.18, SD=4.24), but significantly higher ToMI scores reported by parents of TD children (M=11.63, SD=4.49). ToM and ToMI scores were moderately correlated, r(40)=.37, p=.018.

Conclusions:  Our findings suggest that three-year-old children with ASD or DD demonstrate significant delays in their desire-belief understanding compared to TD children across modalities, and that parent’s perceptions of their child’s understanding of beliefs and desires coincide with their child’s performance on ToM tasks. Future studies should look at desire-belief understanding in older children with ASD and DD to document the developmental trajectories of these abilities and to investigate how children with ASD and DD might differ from TD children on other ToM constructs, such as knowledge/ignorance and false beliefs. Furthermore, additional research linking parent’s perceptions of their child’s ToM skills with children’s performance on ToM tasks may inform the development of parent-mediated interventions that address social-cognitive developmental delays in children with ASD and DD