Joint Attention, Social Referencing, and Theory of Mind in ASD and Non-ASD Children

Background: Joint attention and theory of mind are both integral parts of a core social-communicative system that begins developing in infancy. While joint attention begins emerging between 6 and 15 months in typically-developing children, theory of mind begins emerging at around 4 years. Although longitudinal data suggests a relationship between joint attention and theory of mind, little is known about the extent of the relationship and variables that mediate the relationship. Because joint attention emerges before theory of mind, it is possible that joint attention deficits contribute to theory of mind deficits in children with autism spectrum disorder (ASD). Moreover, information regarding the development of joint attention beyond infancy in typically developed children is limited and may facilitate a better understanding of typical vs. atypical socio-cognitive development.

Objectives: The purpose of this study was to explore differences between children with ASD and typically developing children in theory of mind and rates of joint attention and social referencing and to examine the relationships between all three variables. In addition, the study examines the effect of age and joint attention and the effect of age and social referencing on theory of mind in both groups.

Methods: A sample of 20 children with ASD between the ages of 6 and 12 years were compared to a sample of 19 typically-developing children in the same age range. With the exception of one control, who was matched within 1-year, all controls were matched by gender and age within 6-months to children in the ASD group. The groups were assessed at the Eastern Michigan University Psychology Clinic on tests of intelligence and social functioning, including communication, social awareness, social affect, and theory of mind.

Results: The ASD group had lower overall levels of theory of mind and more specifically, verbal theory of mind, than the non-ASD group. In addition, in comparison to the non-ASD group, they had lower instances of initiated joint attention and social referencing. Age was shown to be positively related to theory of mind. In addition, bivariate relationships between language measures and theory of mind measures were found. Joint attention was found to predict theory of mind, with greater attention predicting greater theory of mind. Moreover, verbal language was also found to be related to theory of mind. No relationship between age and theory of mind, even as moderated by joint attention, was found for ASD and non-ASD participants.

Conclusions: Results suggest lower social functioning in the ASD group, as demonstrated by poorer theory of mind and lower rates of joint attention and social referencing. A relationship between language measures and theory of mind measures suggest that children may develop compensatory behaviors which allow them to achieve greater scores in theory of mind. Lastly, the findings suggest that joint attention and verbal language can be used as indicators of theory of mind abilities and deficits in those areas may perhaps be addressed to improve or prevent theory of mind deficits.