Theory of Mind (ToM) refers to the ability to attribute mental states, such as beliefs, desires, and intentions, to oneself and others.
Individuals with Autism Spectrum Disorder (ASD) often show atypical development of ToM skills, which can impact their social understanding and interaction.
Investigating ToM in ASD can provide insights into the unique challenges and strengths in their social cognition.
Fadda, R., Congiu, S., Doneddu, G., Carta, M., Piras, F., Gabbatore, I., & Bosco, F. M. (2024). Th.o.m.a.s: new insights into theory of mind in adolescents with autism spectrum disorder. Frontiers in Psychology, 15, 1461980. https://doi.org/10.3389/fpsyg.2024.1461980
Key Points
- This study investigated Theory of Mind (ToM) abilities in adolescents with Autism Spectrum Disorder (ASD) using the Theory of Mind Assessment Scale (Th.o.m.a.s.).
- Adolescents with ASD were weaker than controls in attributing understanding of others’ mental states in first- and second-order ToM scenarios.
- They showed the same level of awareness about mental states as controls, but were weaker in conceptualizing relationships between mental states and behavior and strategies to achieve desires.
- They performed similarly to controls in understanding emotions, but struggled more with understanding desires and beliefs.
- ToM develops atypically in ASD, with specific strengths and weaknesses in different dimensions. A multidimensional approach provides a detailed profile of mentalizing abilities.
Rationale
Previous research has shown that individuals with ASD often have atypical Theory of Mind (ToM) abilities at different ages (Andreou & Skrimpa, 2020; Brewer et al., 2017).
However, most studies have focused on children, so there is still limited understanding of the actual mentalizing abilities of adolescents and adults with ASD (Livingston et al., 2019).
Moreover, the ToM tasks used in prior studies tend to reduce mindreading to an all-or-nothing phenomenon and have methodological limitations (Livingston & Happé, 2017).
This study aimed to fill these gaps by investigating ToM abilities in adolescents with ASD compared to typically developing controls using a multidimensional tool, the Theory of Mind Assessment Scale (Th.o.m.a.s.).
Method
The study used the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview, to assess different dimensions of ToM in adolescents with ASD and typically developing controls.
The Strange Stories task was also administered to evaluate general ToM abilities.
Procedure
Participants were tested individually in a quiet room. All Th.o.m.a.s. interviews were audio-recorded, transcribed, and rated by two independent judges who were blind to group membership.
The Strange Stories task was also administered.
Sample
The final sample included 18 participants with ASD (3 females, 15 males, mean age 16 years 5 months) and 18 typically developing controls (3 females, 15 males, mean age 16 years 3 months).
All participants with ASD had been diagnosed by expert clinicians according to DSM-5 criteria.
Measures
- Theory of Mind Assessment Scale (Th.o.m.a.s.): a semi-structured interview assessing different dimensions of ToM
- Strange Stories task: evaluates general ToM abilities
Statistical Measures
Repeated measures ANOVAs were conducted to compare the performance of the ASD and control groups on the Th.o.m.a.s. scales, subscales, and dimensions.
Independent t-tests with Bonferroni correction were used for post-hoc comparisons.
Results
The ASD group performed significantly lower than controls on Th.o.m.a.s. scales assessing egocentric third-person perspective and second-order ToM.
They performed similarly to controls on first-person and allocentric third-person ToM scales. The ASD group scored lower on subscales measuring causal relationships between mental states and behavior and strategies to achieve desires, but not on the awareness subscale.
They performed worse than controls on understanding desires and beliefs, but not emotions.
Within-group analyses revealed specific strengths and weaknesses in different ToM dimensions in the ASD group.
Insight
This study provides a nuanced understanding of ToM abilities in adolescents with ASD.
Rather than a global deficit, they show an atypical developmental pattern with specific strengths and weaknesses across different dimensions of mentalizing.
For example, while they struggled with egocentric perspective-taking and higher-order ToM, they performed comparably to controls on first-person and allocentric ToM.
They also had difficulty linking mental states to behaviors and strategies, despite intact awareness of mental states themselves.
Understanding desires and beliefs was more impaired than emotional understanding. These findings highlight the importance of a multidimensional approach to comprehensively assess ToM in ASD.
Future research could further explore these specific profiles longitudinally and their impact on social functioning.
Implications
The findings suggest that interventions for adolescents with ASD should target specific areas of ToM difficulty, such as second-order recursive thinking, egocentric perspective-taking, and the practical application of mental state understanding to behavior and social strategies.
Promoting real-life social experiences in various contexts may be important to develop procedural ToM knowledge.
Clinicians should be aware of the nuanced ToM profiles in ASD to tailor assessments and treatments accordingly.
Future research could investigate developmental trajectories of these ToM dimensions and their cognitive and linguistic correlates.
Strengths
This study had several methodological strengths, including:
- Use of a multidimensional ToM assessment tool (Th.o.m.a.s.) providing a detailed profile
- Inclusion of both ASD and matched typically developing control groups
- Examination of various ToM dimensions (e.g., perspective-taking, type of mental state)
- Blinded independent rating of Th.o.m.a.s. interviews
Limitations
This study also had several methodological limitations, including:
- Relatively small sample size
- Lack of complete information on symptom severity (ADOS scores) for all participants
- Th.o.m.a.s. relies on verbal abilities, so findings may not generalize to the entire autism spectrum
- Cross-sectional design does not allow for examining developmental trajectories
References
Primary reference
Fadda, R., Congiu, S., Doneddu, G., Carta, M., Piras, F., Gabbatore, I., & Bosco, F. M. (2024). Th. omas: new insights into theory of mind in adolescents with autism spectrum disorder. Frontiers in Psychology, 15, 1461980. https://doi.org/10.3389/fpsyg.2024.1461980
Other references
Andreou, M., & Skrimpa, V. (2020). Theory of mind deficits and neurophysiological operations in autism spectrum disorders: a review. Brain Sciences, 10(6), 393. https://doi.org/10.3390/brainsci10060393
Brewer, N., Young, R. L., & Barnett, E. (2017). Measuring theory of mind in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(7), 1927-1941. https://doi.org/10.1007/s10803-017-3080-x
Livingston, L. A., Colvert, E., Social Relationships Study Team, Bolton, P., & Happé, F. (2019). Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 60(1), 102-110. https://doi.org/10.1111/jcpp.12886
Livingston, L. A., & Happé, F. (2017). Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder. Neuroscience & Biobehavioral Reviews, 80, 729-742. https://doi.org/10.1016/j.neubiorev.2017.06.005
Keep Learning
- How might the specific profile of ToM strengths and weaknesses in ASD impact social functioning in everyday life? What compensatory strategies might individuals develop?
- What are some potential factors that could contribute to the atypical development of different ToM dimensions in ASD (e.g., cognitive abilities, social experiences, language skills)?
- How could intervention approaches be tailored to target the specific areas of ToM difficulty highlighted in this study? What types of activities or strategies might be effective?
- What additional measures or methods could be used alongside Th.o.m.a.s. to further explore ToM abilities in ASD, particularly in individuals with lower verbal abilities?
- How might the ToM profiles in ASD compare to those seen in other neurodevelopmental or psychiatric conditions? What could this tell us about the specificity and mechanisms of social cognition differences?
