Journal of Autism and Developmental Disorders

, Volume 48, Issue 2, pp 430–441 | Cite as

Contribution of Theory of Mind, Executive Functioning, and Pragmatics to Socialization Behaviors of Children with High-Functioning Autism

  • Carmen Berenguer
  • Ana Miranda
  • Carla Colomer
  • Inmaculada Baixauli
  • Belén Roselló
Original Paper


Social difficulties are a key aspect of autism, but the intervening factors are still poorly understood. This study had two objectives: to compare the profile of ToM skills, executive functioning (EF), and pragmatic competence (PC) of children with high-functioning autism (HFA) and children with typical development (TD), and analyze their mediator role in social functioning. The participants were 52 children with HFA and 37 children with TD matched on age, intelligence quotient, and expressive vocabulary. Significant differences were found on measures of ToM, both explicit and applied, EF, and PC between children with HFA and TD. Multiple mediation analysis revealed that applied ToM skills and PC mediated the relations between autism symptoms and social functioning. Implications for social cognitive interventions to address these findings are discussed.


High functioning autism Theory of mind Pragmatic competence Executive functioning Social domain 



This work is supported by the Spanish project PSI2016-78109 (AEI/FEDER, UE) and the predoctoral fellowship University of Valencia UV-INV-PREDOC15-265889.

Author Contributions

CB conceived the study, participated in its design, and coordination, interpretation of results and drafted the manuscript; AM conceived the study, participated in the design, coordination of the study, interpretation of the data and manuscript revisions; CC participated in the design and coordination of the study, and data collection; IB participated in the coordination of the study and data collection; BR participated in data analysis and interpretation of results. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

Authors declare no conflict of interest.

Ethical Approval

The study was approved by the Ethics Committee of the University of Valencia (Declaration of Helsinki in the European Council Agreement, 1964).


  1. American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Baixauli-Fortea, I., Roselló-Miranda, B., & Colomer-Diago, C. (2015). Relationships between language disorders and socio-emotional competence. Revista de Neurología, 60, 51–56.Google Scholar
  3. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychology research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefPubMedGoogle Scholar
  4. Baron-Cohen, S. (1995). Mindblindness. Cambridge, MA: MIT Press.Google Scholar
  5. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a ‘theory of mind’? Cognition, 21, 37–46.CrossRefPubMedGoogle Scholar
  6. Bauminger, N. (2007). Brief report: Individual social-multi-modal intervention for HFASD. Journal of Autism and Developmental Disorders, 37, 1593–1604.CrossRefPubMedGoogle Scholar
  7. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 489–507.CrossRefPubMedGoogle Scholar
  8. Bishop, D. V. (2003). The children’s communication checklist: CCC-2. London: Harcourt Assessment.Google Scholar
  9. Bishop-Fitzpatrick, L., Mazefsky, C. A., Eack, S. M., & Minshew, N. J. (2017). Correlates of social functioning in autism spectrum disorder: The role of social cognition. Research in Autism Spectrum Disorders, 35, 25–34.CrossRefPubMedGoogle Scholar
  10. Bora, E., & Pantelis, C. (2016). Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): Comparison with healthy controls and autistic spectrum disorder. Psychological Medicine, 46, 699–716.CrossRefPubMedGoogle Scholar
  11. Brooks, B. L., Sherman, E. M., & Strauss, E. (2009). NEPSY-II: A developmental neuropsychological assessment. Child Neuropsychology, 16, 80–101.CrossRefGoogle Scholar
  12. Callenmark, B., Kjellin, L., Rönnqvist, L., & Bölte, S. (2014). Explicit versus implicit social cognition testing in autism spectrum disorder. Autism: The International Journal of Research and Practice, 18, 684–693.CrossRefGoogle Scholar
  13. Capps, L., Kehres, J., & Sigman, M. (1998). Conversational abilities among children with autism and children with developmental delays. Autism: The International Journal of Research and Practice, 2, 325–344.CrossRefGoogle Scholar
  14. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Science, 16, 231–239.CrossRefGoogle Scholar
  15. Freeman, L. M., Locke, J., Rotheram-Fuller, E., & Mandell, D. (2017). Brief report: Examining executive and social functioning in elementary-aged children with autism. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-017-3079-3.PubMedPubMedCentralGoogle Scholar
  16. Frith, U., Happé, F., & Siddons, F. (1994). Autism and theory of mind in everyday life. Social Development, 3, 108–124.CrossRefGoogle Scholar
  17. Geurts, M., & Embrechts, M. (2008). Language profiles in ASD, SLI and ADHD. Journal of Autism and Developmental Disorders, 38, 1931–1943.CrossRefPubMedGoogle Scholar
  18. Gilotty, L., Kenworthy, L., Sirian, L., Black, D. O., & Wagner, A. E. (2002). Adaptive skills and executive function in autism spectrum disorders. Child Neuropyschology, 8, 241–248.CrossRefGoogle Scholar
  19. Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Test review behavior rating inventory of executive function. Child Neuropsychology, 6, 235–238.CrossRefGoogle Scholar
  20. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: The Guilford Press.Google Scholar
  21. Helland, W. A. (2014). Differentiating children with specific language impairment and children with Asperger syndrome using parental reports. Annals of Psychiatry and Mental Health, 2, 1013.Google Scholar
  22. Helland, W. A., Biringer, E., Helland, T., & Heimann, M. (2009). The usability of a norwegian adaptation of the children’s communication checklist second edition (CCC-2) in differentiating between language impaired and non-language impaired 6-to 12-year-olds. Scandinavian Journal of Psychology, 50, 287–292.CrossRefPubMedGoogle Scholar
  23. Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8, 26–32.CrossRefPubMedGoogle Scholar
  24. Hughes, C., & Devine, R. T. (2015). A social perspective on theory of mind. In M. E. Lamb (Ed.), Handbook of child psychology and developmental science: Socioemotional processes (pp. 564–609). Hoboken, NJ: Wiley.Google Scholar
  25. Hutchins, T. L., Prelock, P. A., & Bonazinga, L. (2012). Psychometric evaluation of the theory of mind Inventory (ToMI): A study of typically developing children and children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42, 327–341.CrossRefPubMedGoogle Scholar
  26. Hutchins, T. L., Prelock, P. A., & Bonazinga, L. (2014). Technical manual for the theory of mind inventory and theory of mind task battery. Unpublished copyrighted manuscript.
  27. Hutchins, T. L., Prelock, P. A., Morris, H., Benner, J., LaVigne, T., & Hoza, B. (2016). Explicit vs applied theory of mind competence: A comparison of typically developing males, males with ASD, and males with ADHD. Research in Autism Spectrum Disorder, 21, 94–108.CrossRefGoogle Scholar
  28. Jahromy, L. B., Bryce, C. I., & Swanson, J. (2013). The importance of self-regulation for the school and peer engagement of children with high-functioning autism. Research in Autism Spectrum Disorders, 7, 235–246.CrossRefGoogle Scholar
  29. Kaufman, A. S., & Kaufman, N. I. (2000). K-BIT, Test breve de inteligencia de Kauffman [Kaufman brief intelligence test]. Madrid: Pearson.Google Scholar
  30. Kimhi, Y. (2014). TOM abilities and deficits in autism spectrum disorders. Topics in Language Disorders, 34, 329–343.CrossRefGoogle Scholar
  31. Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007). Social communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: The Vineland and the ADOS. Journal of Autism and Developmental Disorders, 37, 748–759.CrossRefPubMedGoogle Scholar
  32. Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY-II: A developmental neuropsychological assessment. San Antonio, TX: The Psychological Corporation.Google Scholar
  33. Lam, Y. G., & Yeung, S. S. (2012). Towards a convergent account of pragmatic language deficits in children with high-functioning autism: Depicting the phenotype using the pragmatic rating scale. Research in Autism Spectrum Disorders, 6, 792–797.CrossRefGoogle Scholar
  34. Laugeson, E., Ellingsen, R., Sanderson, J., Tucci, L., & Bates, S. (2014). The ABC’s of teaching social skills to adolescents with autism spectrum disorder in the classroom: The UCLA PEERS (©) Program. Journal of Autism and Developmental Disorders, 44, 2244–2256.CrossRefPubMedGoogle Scholar
  35. Leonard, M. A., Milich, R., & Lorch, E. P. (2011). The role of pragmatic language use in mediating the relation between hyperactivity and inattention and social skills problems. Journal of Speech, Language and Hearing Research, 54, 567–579.CrossRefGoogle Scholar
  36. Leung, R. C., Vogan, V. M., Powell, T. L., Anagnostou, E., & Taylor, M. J. (2016). The role of executive functions in social impairment in autism spectrum disorder. Child Neuropsychology, 22, 336–344.CrossRefPubMedGoogle Scholar
  37. Li, J., Zhu, L., Liu, J., & Li, X. (2014). Social and non-social deficits in children with high-functioning autism and their cooperative behaviors. Research in Autism Spectrum Disorders, 8, 1657–1671.CrossRefGoogle Scholar
  38. MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Maldonado Belmonte, M. J. (2016). Adaptation of the behavior rating inventory of executive function (BRIEF) to the spanish population and its usefulness for the diagnosis of attention deficit hyperactivity disorder inattentive and combined subtypes. Doctoral dissertation, Universidad Complutense de Madrid, Spain.Google Scholar
  40. Mazza, M., Mariano, M., Peretti, S., Masedu, F., Pino, M. C., & Valenti, M. (2017). The role of theory of mind on social information processing in children with autism spectrum disorders: A mediation analysis. Journal of Autism and Developmental Disorders, 47, 1369–1379.CrossRefPubMedGoogle Scholar
  41. Miranda-Casas, A., Baixauli-Fortea, I., Colomer-Diago, C., & Roselló-Miranda, B. (2013). Autismo y trastorno por déficit de atención con hiperactividad. Convergencias y divergencias en funcionamiento ejecutivo y teoría de la mente [Autism and attention deficit hyperactivity disorder: Similarities and differences in executive functioning and theory of mind]. Revista de Neurología, 57, 177–184.Google Scholar
  42. Orinstein, A. J., Suh, J., Porter, K., De Yoe, K. A., Tyson, K. E., Troyb, E., et al. (2015). Social function and communication in optimal outcome children and adolescents with an autism history on structured test measures. Journal of Autism and Developmental Disorders, 45, 2443–2463.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Parsons, L., Cordier, R., Munro, N., Joosten, A., & Speyer, R. (2017). A systematic review of pragmatic language interventions for children with autism spectrum disorder. PLoS ONE, 12(4), e0172242.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Peterson, C., Garnett, M., Kelly, A., & Attwood, T. (2009). Everyday social and conversation applications of theory-of-mind understanding by children with autism-spectrum disorders or typical development. European Child and Adolescent Psychiatry, 18, 105–115.CrossRefPubMedGoogle Scholar
  45. Peterson, C., Slaughter, V., Moore, C., & Wellman, H. M. (2016). Peer social skills and theory of mind in children with autism, deafness, or typical development. Developmental Psychology, 52, 46–57.CrossRefPubMedGoogle Scholar
  46. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments & Computers, 36, 717–731.CrossRefGoogle Scholar
  47. Pugliese, C. E., Anthony, L., Strang, J. F., Dudley, K., Wallace, G. L., & Kenworthy, L. (2015). Increasing adaptive behavior skill deficits from childhood to adolescence in autism spectrum disorder: Role of executive function. Journal of Autism and Developmental Disorders, 45, 1579–1587.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Pujals, E., Batlle, S., Camprodon, E., Pujals, S., Estrada, X., Aceña, M., et al. (2016). Brief report: Translation and adaptation of the theory of mind inventory to spanish. Journal of Autism and Developmental Disorders, 46, 685–690.CrossRefPubMedGoogle Scholar
  49. Resches, M., & Pérez-Pereira, M. (2007). Referential communication abilities and Theory of Mind development in preschool children. Journal of Child Language, 34, 21–52.CrossRefPubMedGoogle Scholar
  50. Russell, G., Golding, J., Norwich, B., Emond, A., Ford, T., & Steer, C. (2012). Social and behavioural outcomes in children diagnosed with autism spectrum disorders: A longitudinal cohort study. Journal of Child Psychology and Psychiatry, 53, 735–744.CrossRefPubMedGoogle Scholar
  51. Rutter, M., Bailey, A., & Lord, C. (2003a). Social communication questionnaire. Los Angeles: Western Psychological Services.Google Scholar
  52. Rutter, M., Le Couteur, A., & Lord, C. (2003b). ADI-R. Autism diagnostic interview revised. Manual. Los Angeles: Western Psychological Services.Google Scholar
  53. Scheeren, A. M., de Rosnay,, M., Koot,, H. M., & Begeer, S. (2013). Rethinking theory of mind in high-functioning autism spectrum disorder. Journal of Child Psychology and Psychiatry, 54, 628–635.CrossRefPubMedGoogle Scholar
  54. Schwenck, C., Mergenthaler, J., Keller, K., Zech, J., Salehi, S., Taurines, R., et al. (2012). Empathy in children with autism and conduct disorder: Group-specific profiles and developmental aspects. Journal of Child Psychology and Psychiatry, 53, 651–659.CrossRefPubMedGoogle Scholar
  55. Senju, A. (2012). Spontaneous theory of mind and its absence in autism spectrum disorder. The Neuroscientist, 18, 108–113.CrossRefPubMedGoogle Scholar
  56. Senju, A., Southgate, V., White, S., & Frith, U. (2009). Mindblind eyes: An absence of spontaneous theory of mind in asperger syndrome. Science, 325, 883–885.CrossRefPubMedGoogle Scholar
  57. Snow, C., Cancino, H., Gonzalez, P., & Shriberg, E. (1989). Giving formal definitions: An oral language correlate of school literacy. In D. Bloome (Ed.), Classrooms and literacy (pp. 233–249). Norwood, NJ: Ablex.Google Scholar
  58. Sparrow, S. S., Cicchetti, D. V., & Balla, D. (2005). The vineland II adaptive behavior scales. Circle Pines, MN: American Guidance Service.Google Scholar
  59. Tager-Flusberg, H. (1999). A psychological approach to understanding the social and language impairments in autism. International Review of Psychiatry, 11, 325–334.CrossRefPubMedPubMedCentralGoogle Scholar
  60. Tager-Flusberg, H., & Sullivan, K. (1995). Attributing mental states to story characters: A comparison of narratives produced by autistic and mentally retarded individuals. Applied Psycholinguistics, 16, 241–256.CrossRefGoogle Scholar
  61. Volden, J., Coolican, J., Garon, N., White, J., & Bryson, S. (2009). Brief report: Pragmatic language in autism spectrum disorder: Relationships to measures of ability and disability. Journal of Autism and Developmental Disorders, 39, 388–393.CrossRefPubMedGoogle Scholar
  62. Volden, J., & Phillips, L. (2010). Measuring pragmatic language in speakers with autism spectrum disorders: Comparing the Children’s Communication Checklist—2 and the Test of Pragmatic Language. American Journal of Speech-Language Pathology, 19, 204–212.CrossRefPubMedGoogle Scholar
  63. Vulchanova, M., Saldaña, D., Chahboun, S., & Vulchanov, V. (2015). Figurative language processing in atypical populations: The ASD perspective. Frontiers in Human Neuroscience, 9, 1–11.CrossRefGoogle Scholar
  64. Wallace, G. L., Yerys, B. E., Peng, C., Dlugi, E., Anthony, L. G., & Kenworthy, L. (2016). Chapter three-assessment and treatment of executive function impairments in autism spectrum disorder: An update. International Review of Research in Developmental Disabilities, 51, 85–122.CrossRefGoogle Scholar
  65. Wechsler, D. (2003). Wechsler intelligence scale for children, fourth edition (WISC-IV). San Antonio, TX: The Psychological Corporation.Google Scholar
  66. Whyte, E., & Nelson, K. (2015). Trajectories of pragmatic and nonliteral language development in children with autism spectrum disorders. Journal of Communication Disorders, 54, 2–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Carmen Berenguer
    • 1
  • Ana Miranda
    • 1
  • Carla Colomer
    • 2
  • Inmaculada Baixauli
    • 3
  • Belén Roselló
    • 1
  1. 1.Department of Educational PsychologyFaculty of Psychology - University of ValenciaValenciaSpain
  2. 2.Department of Education, Didactics and School OrganizationJaume I UniversityCastellón de la PlanaSpain
  3. 3.Department of Occupational Sciences, Speech Therapy, Evolutionary and Educational Psychology, Faculty of Psychology, Teaching and Education SciencesCatholic University of Valencia “San Vicente Mártir”ValenciaSpain

Personalised recommendations