Understanding Other People: Theory of Mind in Toddlers and Preschoolers with Autism Spectrum Disorder

Background: Theory of Mind (ToM) refers to the ability to understand the subjectivity of people’s intentions, desires and beliefs. Research has shown that the development of this capacity is significantly delayed in children with an autism spectrum disorder (ASD). These studies have mainly focused on false belief understanding, while ToM is grounded on three fundamental mental concepts: intentions, desires and beliefs, which develop in a fixed order in TD children. Especially knowledge concerning intention understanding in children with ASD is limited. Moreover, to date, little research in this domain has included toddlers and preschoolers with ASD.

Objectives: The purpose of this study was to assess separate aspects of ToM functioning in young children with ASD compared with typically developing (TD) peers in order to gain more insight into ToM development in children with ASD.

Methods: The study included 139 children (66 with ASD, 73 TD, 21-72 months). A broad range of low-verbal-demand tasks were administered to measure various aspects of intention, desire and belief understanding.

Results: The outcomes showed that children with ASD understood two aspects of other people’s intentions to the same extent as TD children. Yet, children with ASD scored significantly lower than TD children on imperative comprehension; the ability to understand that someone intends to direct their attention in order to request an object. In addition, the ASD group scored lower on a desire task in which the protagonist preferred undesirable food items. No significant differences were found between both groups on false belief understanding.

Conclusions: Compared with the TD group, children with ASD did not show a delay in the first stage of ToM development: understanding other people’s intentions, except for imperative comprehension. Yet, this involves responding to the other person’s desire, which includes a motivational component. Additionally, children with ASD showed difficulties in acknowledging the subjective character of desires in an uncommon desire task. These outcomes indicate that a delay in ToM development is already present in toddlers and preschoolers. The absence of a difference in false belief understanding seems to contradict this. However, this finding could be explained by the young age of the samples; both groups had low scores on these tasks because belief understanding is still very much in development.