Development of Theory of Mind in Autism

Theory of Mind (ToM) is a critical aspect of social cognition and undergoes significant developmental changes from infancy to adulthood. This development follows a trajectory marked by key milestones, with notable differences between autistic and non-autistic individuals.

Infancy and Early Childhood

ToM development begins in infancy, where social interaction plays a vital role. Infants depend on caregivers to regulate affective states, which in turn helps in the gradual acquisition of self-regulatory abilities—an essential foundation for later socio-emotional skills and ToM (Nonnemacher et al. 2021). Early differences in ToM between neurotypical and autistic children become evident in infancy, particularly in social engagement and joint attention. Autistic infants often exhibit less eye contact and reduced responsiveness to social cues, which can impact their later development of ToM-related skills (Wang et al. 2022).

Preschool years mark a crucial period for ToM development. Around age four, typically developing children acquire an understanding of false beliefs—the ability to recognise that others may hold beliefs different from reality (Wellman, 2020). However, children with ASD often struggle with false-belief tasks, indicating a delayed or atypical ToM development (Wang et al. 2022).

Middle Childhood and Adolescence

Advanced ToM (AToM) begins to develop in middle childhood, with children gaining an understanding of recursive thinking—the ability to comprehend multiple levels of belief reasoning (Osterhaus & Koerber 2021). Typically, by the age of seven, neurotypical children grasp the concept that mental states can be recursive, further enhancing their social cognition (Osterhaus & Koerber 2021). In contrast, children with ASD tend to exhibit persistent challenges in understanding more complex social interactions and struggle with integrating multiple perspectives (Valle et al. 2015).

Adolescence is a crucial period for ToM development, particularly in refining social-perceptual and social-cognitive components (Meinhardt-Injac et al. 2020). While neurotypical adolescents show substantial improvement in both areas, autistic individuals often continue to struggle with interpreting social cues and understanding others' intentions (Meinhardt-Injac et al. 2020). These difficulties can contribute to social challenges, including peer rejection and increased feelings of loneliness (Banerjee et al. 2011; Devine et al. 2016).

Adulthood and Aging

ToM continues to evolve into adulthood, though its application varies. Even healthy adults demonstrate limitations in ToM use, particularly in situations requiring complex social reasoning (Apperly et al. 2010). Additionally, ToM abilities typically decline in aging adults, affecting their ability to infer others' emotions and intentions (Henry et al. 2013). However, research suggests that autistic adults may not experience the same degree of ToM decline. Zıvralı Yarar et al. (2021) found that, unlike their neurotypical peers, older autistic adults performed similarly to younger autistic adults on ToM tasks, indicating a possible protective effect of ASD on ToM deterioration.

The Impact of ToM on Social Functioning

The development of ToM follows a complex trajectory, with significant milestones occurring in infancy, childhood, and adolescence. ToM is closely linked to social development and functioning. Neurotypical children with stronger ToM abilities tend to exhibit higher prosocial behaviour, are more popular among peers, and form more reciprocated friendships (Fink et al. 2015; Slaughter et al. 2015; Imuta et al. 2016). In contrast, autistic individuals, who often exhibit ToM deficits, may struggle with social integration, displaying lower levels of prosocial behaviour and experiencing higher rates of social rejection (Wang et al. 2022).