Theory of Mind, Language, Cognition, and Symptoms of Autism in Youth with Autism Spectrum Disorder

Abstract The purpose of the current study was to explore the development of theory of mind (ToM) as measured by the Reading the Mind in the Eyes Test-Children (RMET-C) in youth with autism, and to determine evidence for a relationship between performance on RMET-C and cognitive skills, language skills, as well as impairments associated with autism as measured by the ADOS. The data was derived from a genetics study on autism and in total, there were 91 participants diagnosed with autism spectrum disorder (ASD) who were divided into five groups based on age: 6-8, 8-10, 10-12, 12-16, and 16-20 years. First, compared to the published data for typically developing youth for mean performance on the RMET-C, participants with ASD in the 8-10, 10-12, and 12-16 age groups performed significantly lower; however, unlike participants in the typically developing groups, they continued to improve their performance beyond 12 years of age. Based on the DSM-IV classification of autism, individuals with Aspergers performed significantly better than PDD-NOS and ASD PDD groups on the RMET-C before adjusting for verbal and nonverbal IQ. Second, for youth with ASD, when language skills (expressive and receptive) were statistically taken into account, verbal IQ ceased to be predictive of performance on the RMET-C. Language skills were significantly correlated with RMET-C performance across four age groups (all except 6-8), whereas verbal IQ was significantly correlated in two of the age groups, 8-10 and 10-12. Non-verbal IQ was significantly correlated with RMET-C performance in three age groups, 8-10, 10-12, and 12-16. Third, participants with ASD were less efficient at identifying positive feelings and slightly less efficient at identifying positive mental states than negative feelings and negative mental states, although there were differences in frequencies of responses to specific items on the RMET-C. The question with the highest frequency of correct response was from the negative valence category (upset) and one with the least frequent correct response was from positive valence category (friendly). Fourth, based on ADOS-II classification for Module 3, there was no association between the increased symptoms of autism on the Social Affect nor on the RRB scale and performance on the RMET-C. Based on the ADOS I classification of the same module, better scores on the Communication domain were related to increased performance on the RMET-C. On ADOS II for Module 4, better performance on the Communication domain and SBRT scale was associated with higher performance on the RMET-C. There was no significant correlation between Reciprocal Social Interaction and performance on the RMET-C. Correlations between individual items on the ADOS (Modules 3 and 4) and performance on the RMET-C were also explored. Lastly, anxiety scores on Module 3 and 4 of the ADOS were not significantly correlated to performance on the RMET-C. The present findings are discussed with respect to existing empirical literature and theoretical paradigms (Eye Avoidance, Affective, Metarepresentation, Language, Alexithymia and Evolutionary theories). Implications for practice, policy, and future research are also presented