Associations between theory of mind and conduct problems in autistic and nonautistic youth.
After accounting for verbal IQ, theory-of-mind deficits do not uniquely predict conduct problems in autistic youth.
01Research in Context
What this study did
Carter Leno et al. (2021) asked if poor theory-of-mind skills cause conduct problems in autistic teens.
They tested autistic and non-autistic youth aged 11-18. Each teen took a ToM story test and a conduct rating scale.
The team used verbal IQ as a control. They wanted to see if ToM still mattered after IQ was held steady.
What they found
At first, teens with lower ToM scores did show more conduct, hyper, and mood problems.
Once verbal IQ was added, the link vanished. Verbal IQ, not ToM, predicted the behavior scores.
The same pattern held for both autistic and non-autistic youth.
How this fits with other research
The finding lines up with Amorim et al. (2025). That study looked at autism, ADHD, OCD, and NT kids. IQ and social-comm skills predicted ToM far better than any label.
It also echoes Granader et al. (2014) with preschoolers. When IQ was held steady, ToM gaps between autistic and NT kids shrank.
Carter Leno et al. (2019) seems to clash. Their earlier survey said ToM deficits forecast self-injury in autistic teens. The key difference: the 2019 paper did not control for verbal IQ. Once you add that control, the unique ToM effect disappears.
Why it matters
If you see conduct issues in an autistic teen, do not assume ToM training will fix them. Check verbal IQ first. Boost language and general learning supports. These may ease both behavior and social growth more than social-cognition drills alone.
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02At a glance
03Original abstract
Many autistic young people exhibit co-occurring behavior difficulties, characterized by conduct problems and oppositional behavior. However, the causes of these co-occurring difficulties are not well understood. Impairments in theory of mind (ToM) are often reported in autistic individuals and have been linked to conduct problems in nonautistic individuals. Whether an association between ToM ability and conduct problems exists in autistic populations, whether this association is similar between individuals who are autistic versus nonautistic, and whether these associations are specific to conduct problems (as opposed to other domains of psychopathology) remains unclear. ToM ability was assessed using the Frith-Happé Triangles task in a pooled sample of autistic (N = 128; mean age 14.78 years) and nonautistic youth (N = 50; mean age 15.48 years), along with parent-rated psychiatric symptoms of conduct problems, hyperactivity/inattention and emotional problems. Analyses tested ToM ability between autistic versus nonautistic participants, and compared associations between ToM performance and conduct problems between the two groups. Where no significant group differences in associations were found, the pooled association between ToM and conduct problems was estimated in the combined sample. Results showed no evidence of moderation in associations by diagnostic status, and an association between poorer ToM ability and higher levels of conduct problems, hyperactivity/inattention and emotional problems across the total sample. However, these associations became nonsignificant when adjusting for verbal IQ. Results provide support for theoretical models of co-occurring psychopathology in autistic populations, and suggest targets for intervention for conduct problems in autistic youth. LAY SUMMARY: Many young people with autism spectrum disorder show co-occurring behavior problems, but the causes of these are not well understood. This paper found an association between difficulties recognizing what others think and intend (so-called "theory of mind") in a simple animated task, and emotional and behavioral problems in autistic and nonautistic young people. However, a substantial part of this association was explained by individual differences in verbal ability. These findings may have implications for intervention efforts to improve young people's mental health.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2346