The Role of Theory of Mind in the Daily Living Skills of Children with ASD

Background: Children with autism spectrum disorder (ASD) commonly exhibit deficits in activities of daily living (ADL) skills when compared to typically developing (TD) peers (Bal et al., 2015). Additionally, social deficits are defining characteristics of children with ASD (APA, 2013) and have been shown to predict decreased ADL abilities (Bal et al., 2015). The present study hypothesized that that the ADL deficits seen in children with ASD are related to Theory of Mind (ToM), an indicator of social perception (Kimhi et al., 2014). ToM skills are often impaired in children with ASD (Baron-Cohen, Tager-Flusberg, & Cohen, 1985; Kimhi et al., 2014).

Objectives: This study aimed to develop a greater understanding of how social factors may contribute to decreased ADL skills in children with ASD.  Therefore, the purpose of this study was to test our hypothesis that ToM abilities would moderate the association between children’s status and their ADL skills.

Methods: Participants included seventy-two children, ages 3:0 to 6:11. Twenty-two children were previously diagnosed with ASD and 50 children were TD. Children completed a ToM battery in a laboratory setting. Parents’ ratings from the BASC-2 (Reynolds & Kamphaus, 2004) were used to evaluate children’s ADL skills. Additionally, the DAS-II (Elliott, 2007) was used to assess children’s language abilities.

Results: A moderation analysis using the SPSS macro PROCESS (Hayes, 2013) tested whether the association between developmental status and ADL skills was moderated by ToM abilities. Controlled variables included children’s language abilities and age. The main effect of status on ADL skills was significant (B = -45.93, SE = 14.96, p < .001) but the main effect of ToM skills on ADL skills was not significant (B = .09, SE = .88, p = .14). The contribution of the interaction between status and ToM was significant, ΔR² = .04, F(21, 66) = 4.64, p < .05. Specifically, children with ASD who had low (-1 SD; B =-20.26, SE = 4, p < .001) and mean (B =-13.82, SE = .2.91, p < .001) levels of ToM abilities had lower ADL skills when compared to TD children. However, when children with ASD had greater ToM abilities (+1 SD; B = -7.38, SE = 4.34, p = .09), their ADL scores were not significantly different from TD children.  This suggests children with ASD may have comparable ADL skills when they also display higher ToM abilities. 

Conclusions: These results supported our hypothesis that the association between status and ADL skills would be moderated by ToM abilities. Specifically, when children with ASD had low or mean levels of ToM abilities, they had greater deficits in ADL skills than TD children.  However, this relation was not significant for children with ASD who had ToM abilities above the mean, which suggests that their high ToM skills may buffer them against potential deficits in their daily living skills which are characteristic of ASD. The findings suggest that targeting interventions to increase ToM abilities may play a role in improving ADL skills for children with ASD and, therefore, improve independence.