Kuan-Lin Chen

Purpose Mixed results exist regarding the relationships between theory of mind (ToM) and social functioning in children with autism. This inconsistency may stem from a predominant focus on explicit ToM knowledge, with insufficient consideration of applied ToM competence and verbal comprehension. Further research is needed to incorporate these factors into the understanding of social functioning. This study developed mediation models to examine the links among explicit ToM knowledge, caregiver-perceived applied ToM competence, verbal comprehension, and social functioning in children with autism. Methods A total of 202 children with autism (183 boys) and their caregivers participated in this study. The children completed standardized assessments of verbal comprehension and explicit ToM knowledge. Caregivers completed questionnaires assessing the children’s applied ToM competence and social functioning, including subdomains of Interpersonal Relationships, Play and Leisure, and Coping Skills. Results Verbal comprehension showed significantly direct effects across all social functioning subdomains (effects: 0.05–0.15, 95%CI: 0.01–0.25). Explicit ToM knowledge was associated with social functioning only through verbal comprehension and applied ToM competence, or both (effects: 0.20–0.78, 95%CI: 0.04–1.37). Conclusions The results suggest that verbal comprehension may play an important role in linking explicit ToM knowledge to social functioning, whereas explicit ToM knowledge alone may be insufficient to explain social functioning in children with autism. Caregiver-perceived applied ToM competence may represent an additional pathway to social functioning. These findings highlight the importance of considering verbal comprehension, explicit ToM knowledge, and caregiver-perceived applied ToM competence when understanding and improving social functioning in children with autism.

Autistic children often show reduced theory of mind (ToM). However, existing ToM measures neither sufficiently distinguish ToM ability from performance nor interpret both scores effectively, limiting their interpretability and clinical utility. To resolve these limitations, we characterized the measurement‐based functioning levels and correspondence between ToM ability and performance among preschool to school‐aged children. Data from 288 autistic and 168 neurotypical children were analyzed using a multidimensional Rasch model. The functioning levels and correspondence were established using expected responses across statistically distinguishable ToM levels. The results revealed three levels of ToM ability—Early (failure on all items), Basic (success on desire‐based emotion), and Advanced (success on all items)—and five levels of ToM performance: Pre‐ToM (understanding needs and wants), Emerging (simple emotion recognition), Transition (first‐order false belief), Premature (contextual understanding), and Mature (pragmatic understanding). Importantly, while ToM performance tended to improve with ToM ability, only 20% of the items were comparable with neurotypical children. In conclusion, our findings highlight a critical gap in autistic children and provide the first empirically derived functioning framework linking ToM ability and performance. Beyond theoretical contribution, this study offers a practical pathway toward valid assessments and tailored interventions that target children's specific social‐cognitive needs.

There is a growing need to examine how Theory of Mind (ToM) abilities impact real‐time social engagement in autistic children. Caregivers of 45 young autistic children (70.7 ± 23.3 months) and those of 36 neurotypical peers (59.2 ± 11.8 months) carried a mobile device for 7 days to repeatedly record their child's social interactions and in‐the‐moment anxiety. They also completed the Social Responsiveness Scale‐2 and the Theory of Mind Inventory‐2 to evaluate their child's severity of autistic symptoms and ToM abilities. Multilevel analyses found that young autistic children with higher ToM abilities were more likely than those with lower abilities to interact with peers (OR = 1.12, 95% CI = 1.01–1.23) but also experienced more anxiety during interactions with both peers and adults (OR = 1.36, 1.28, 95% CI = 1.12–1.67, 1.01–1.63). In contrast, no significant associations between ToM and social interactions or anxiety were found in the neurotypical group. This study highlights the critical role of ToM abilities in the real‐life social engagement of autistic children and emphasizes the importance of understanding real‐time subjective social experiences.

Existing theory of mind (ToM) measures for children meet challenges from three perspectives. Developmentally, they lack items covering the entire spectrum of ToM abilities, namely, the early, basic and advanced levels. Dimensionally, most measures are unidimensional, not distinguishing between cognitive and affective ToM. Practically, most measures rely heavily on verbal abilities or lack engaging formats. This study aimed to address these critical issues by developing a Theory of Mind Assessment (ToMA). The items were generated based on classical scenarios spanning all developmental levels. The responses from 574 neurotypical children aged 37 to 194 months were analysed using the multidimensional Rasch model. Ten items showed satisfactory model fits when classified into cognitive (4 items) and affective (6 items) domains, with 16 misfit items excluded. Two items seemed easier for girls and two for boys, and the item difficulties were adjusted. The mean Rasch person reliabilities were 0.78 and 0.81. The scores exhibited small and high correlations with subjective and objective criteria. The newly developed measure may offer reliable, valid and sex‐unbiased assessments while satisfying developmental, multidimensional and practical requirements. It seems promising for application in clinical and research settings and is worthy of future refinement and validation to provide high‐quality ToM assessment.

Background: Origami is a popular activity among preschool children and can be used by therapists as an evaluation tool to assess children’s development in clinical settings. It is easy to implement, appealing to children, and time-efficient, requiring only simple materials—pieces of paper. Furthermore, the products of origami may reflect children’s ages and their visual-motor integration (VMI) development. However, therapists typically evaluate children’s origami creations based primarily on their personal background knowledge and clinical experience, leading to subjective and descriptive feedback. Consequently, the effectiveness of using origami products to determine children’s age and VMI development lacks empirical support. Objective: This study had two main aims. First, we sought to apply artificial intelligence (AI) techniques to origami products to predict children’s ages and VMI development, including VMI level (standardized scores) and VMI developmental status (typical, borderline, or delayed). Second, we explored the performance of the AI models using all combinations of photographs taken from different angles. Methods: A total of 515 children aged 2-6 years were recruited and divided into training and testing groups at a 4:1 ratio. Children created origami dogs, which were photographed from 8 different angles. The Beery–Buktenica Developmental Test of Visual-Motor Integration, 6th Edition, was used to assess the children’s VMI levels and developmental status. Three AI models—ResNet-50, XGBoost, and a multilayer perceptron—were combined sequentially to predict age z scores and VMI z scores using the training group. The trained models were then tested using the testing group, and the accuracy of the predicted VMI developmental status was also calculated. Results: The R ² of the age and the VMI trained models ranged from 0.50 to 0.73 and from 0.50 to 0.66, respectively. The AI models that obtained an R ² >0.70 for the age model and an R ² >0.60 for the VMI model were selected for model testing. Those models were further examined for the accuracy of the VMI developmental status, the correlations, and the mean absolute error (MAE) of both the age and the VMI models. The accuracy of the VMI developmental status was about 71%-76%. The correlations between the final predicted age z score and the real age z score ranged from 0.84 to 0.85, and the correlations of the final predicted VMI z scores to the real z scores ranged from 0.77 to 0.81. The MAE of the age models ranged from 0.42 to 0.46 and those of the VMI models ranged from 0.43 to 0.48. Conclusion: Our findings indicate that AI techniques have a significant potential for predicting children’s development. The insights provided by AI may assist therapists in better interpreting children’s performance in activities.

Current assessments of social competence for children with autism spectrum disorder (ASD) are mostly designed for screening or diagnosis, not for measuring outcomes. This study aimed to develop a professional-administrated outcome measure, the Observational Social Competence Assessment (OSCA), and examine its psychometric properties. The OSCA was constructed based on a multidimensional view of social competence (i.e., social skill elements, social reciprocity, and social adjustment). For psychometric evaluation, 89 children with ASD between 3 and 12 years (mean = 70.69 months, SD = 15.31) were assessed with the OSCA and with assessments of ASD symptoms, verbal comprehension ability, and adaptive function. The results show that the OSCA has good internal consistency (Cronbach’s α = 0.820–0.954), test–retest reliability (intraclass correlation coefficients [ICC] = 0.917–0.960), and inter-rater reliability (ICC = 0.905–0.974). The OSCA also has good convergent (r = 0.508–0.703, p < 0.01) and divergent validity (r = 0.105, p = 0.496), as well as good responsiveness to changes in the social adjustment dimension (Cohen’s d = 1.26 and standardized response mean [SRM] = 1.92). Conclusively, these results show that the OSCA is sufficiently reliable, valid and responsive to be applied as an outcome measure of social competence in children with ASD.

Introduction: Theory of mind (ToM) refers to the ability to understand and attribute mental states to oneself and others. A ToM measure is warranted for preschool children to assess their ToM development from a multidimensional perspective (i.e., cognitive and affective dimensions). This study aimed to develop the Preschool Theory of Mind Assessment (ToMA-P) and to evaluate its construct validity and applicability.Methods: The ToMA-P was developed based on comprehensive literature review and revised with expert panel feedback. Its psychometric properties were evaluated in 205 typically developing preschoolers with Rasch analysis for its dimensionality, item difficulties, and convergent validity.Results: The results indicated that all ToMA-P items, except for one, fit the hypothesized two-dimensional construct. The item difficulties in the cognitive and affective dimensions followed developmental sequences. The ToMA-P scores exhibited good convergent validity, as evidenced by its significant correlations with age, verbal comprehension, adaptive functions, and daily ToM performance (p < 0.05). Children’s responses and behaviors also showed that the ToMA-P has good applicability.Discussion: This study provides empirical evidence that the ToMA-P measures cognitive and affective ToM following developmental sequences, and that it has potential as a clinical tool for assessing ToM in preschool children.